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Rates of suicidal thoughts and behaviors are increasing among preadolescent children, yet there is a paucity of longitudinal research among this developmental group. This study evaluated prospective associations between current and lifetime psychiatric disorders and first-onset suicidal ideation (SI), first-onset suicide attempts (SA), and the transition from SI to SA over the course of preadolescence, and estimated the prevalence of psychiatric treatment utilization among preadolescents with SI and SA. Data were drawn from the Adolescent Brain Cognitive Development study. Preadolescents ages 9-10 from 21 sites across the country completed follow-up assessments every 12 months. The sample was restricted to preadolescents under age 13 at their two-year follow-up (n = 9940). In multivariate models, current major depressive disorder (MDD OR = 2.14, [95% CI = 1.10-4.15]), obsessive-compulsive disorder (OCD OR = 1.42, 95%CI = [1.12-1.81]), attention-deficit/hyperactivity disorder (ADHD OR = 1.88, [95%CI = 1.49-2.36]), and binge eating disorder (BED OR = 2.42 [95% CI = 1.25-4.72]) were most robustly predictive of first-onset SI. Only lifetime depression predicted first-onset SA (OR = 2.52, [OR = 1.58-4.00]). No disorders predicted the transition from SI to SA. Rates of psychiatric treatment utilization were 29.38% and 53.91% for first-onset SI and SA, respectively. Based on their small effect sizes, MDD, OCD, ADHD and BED may offer modest value in ascertaining risk for SI. Clinicians and researchers may benefit from looking beyond psychiatric disorders to understand risk for SA. Many preadolescents with SI and SA do not present in psychiatric care settings. Widespread risk screenings in other settings (e.g., primary care) may facilitate early detection and reduce the treatment gap for children at risk for SI and SA.