Elevated symptoms of mania (ESM) are increasingly prevalent among children seeking care for psychiatric distress. Characterized as marked extremes in mood accompanied by intense irritability, ESM is the hallmark feature of bipolar disorder, which is also being diagnosed in children at increasingly high rates. However, ESM does not on its own indicate a bipolar diagnosis, and there is currently no reliable means of predicting whether a child with ESM will ultimately develop bipolar disorder. Given the rising prevalence of Bipolar spectrum disorders in clinical settings, the lasting consequences that accompany such a diagnosis, and the implications for providing treatment, accurately identifying bipolarity in children with ESM presents a critical challenge. This research and policy brief summarizes the ongoing work of CWRU scholars and collaborators to gather and analyze longitudinal data addressing this need and discusses some of the practice and policy implications.