Observing the young child's affect regulation and thought processes during a clinic assessment visit is of critical importance although challenging for children referred for mood disturbance. In this study, parents reported symptoms using standardized clinical interviews and story stems narratives were administered to 20 referred and 12 typically developing preschool age children. Comparison of the referred and typically developing children in our sample showed that specific story contexts varied in eliciting responses reflecting disorganization and thought disturbance from the referred children. The experience of using story stem narratives in the clinical assessment process suggests it provides a valuable complement to parent report for children referred for mood disturbance and mania symptoms but additional development and study of the method is necessary.