• A one-year prospective study was conducted to examine the extent to which type of disability, severity, and family functioning serve to predict maladjustment. One hundred forty children, aged 4 to 13 years, born with cardiovascular disorders, cleft lip or palate, or hearing defects were assessed using the Child Behavior Checklist at two points in time. The results suggest that the type of disorder and severity are associated with remaining or becoming maladjusted. Deaf girls and boys with cardiac problems were most likely to be affected, followed by boys with clefts and boys with hearing problems. A direct relationship is found with severity assessed by the Functional Status Measure. Family functioning, however, is not significantly related to maladjustment. These findings provide a framework for better understanding factors contributing to the increased risk of maladjustment for some children with birth defects.