Objective: Deficits in motor inhibition may contribute to impulsivity and irritability in children with bipolar disorder (BPD). Therefore, studies of the neural circuitry engaged during failed motor inhibition in pediatric BPD may contribute to our understanding of the pathophysiology of the illness. We tested the hypothesis that children with BPD and controls would differ in ventral prefrontal cortex (vPFC), striatal, and anterior cingulate activation during unsuccessful motor inhibition. We also compared activation in medicated vs. unmedicated children with BPD, and in children with BPD and ADHD (BPD+ADHD) vs. those with BPD but without ADHD (BPD-ADHD). Method: Event-related fMRI study comparing neural activation in children with BPD and controls while they performed a motor inhibition task. The sample included 26 children with BPD (13 unmedicated, 15 with ADHD) and 17 age, gender, and IQ matched controls. Results: On failed inhibitory trials, controls showed greater bilateral striatal and right vPFC activation than did patients. While our findings were somewhat more prominent in unmedicated than medicated, patients, and in BPD+ADHD than BPD-ADHD, the findings did not differ significantly (?) among these subgroups of children with BPD. Conclusions: Compared to controls, children with BPD may have deficits in their ability to engage striatal structures and right vPFC during unsuccessful inhibition. (this reads confusingly to me—they’re deficient in their capacity to engage structures when they’re behaviorally unsuccessful? Perhaps reword?) Further research is needed to determine whether these deficits play a role in the emotional and behavioral dysregulation characteristic of BPD.