This study examined the emotional and behavioral adjustment of children with traumatic brain injury (TBI) in school and its relationship to post-injury academic performance and educational interventions. Teachers' ratings of child behavior and academic performance were collected during a prospective, longitudinal study of 53 children with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries, recruited between 6 and 12 years of age. Teachers completed ratings twice during the first year after injury and at an extended follow-up 4 years post-injury. Severe TBI was associated with an elevated rate of emotional and behavioral problems that persisted across time. Poorer adjustment predicted poorer classroom performance and an increased likelihood of educational intervention.