A cohort of 219 children with extremely low birth weight (<1000 g, extremely low birth weight [ELBW]) born from 1992 to 1995 was followed to mean age 8 years to evaluate outcomes and identify risk factors. We compared 204 of these children with 176 term-born normal birth weight (NBW) controls on neuropsychological skills, academic achievement, and adaptive behavior. The ELBW group had worse outcomes than the NBW on all measures. Within the ELBW group, lower scores on NEPSY tests of executive function and memory were related to <750 g birth weight, B (SE) = −0.93 (0.36), p =.010; cranial ultrasound abnormality, B = −1.03 (0.22), p =.002; postnatal steroid therapy, B = −1.00 (0.33), p =.003; and necrotizing enterocolitis, B = −2.26 (0.75), p =.008. A lower score on the Test of Motor Proficiency was related to chronic lung disease, B = −7.33 (1.98), p <.001. Neuropsychological skills mediated the effects of neonatal risk on achievement and adaptive functioning. The findings document the neuropsychological consequences of ELBW at school age in a recently born cohort and identify risks for adverse outcomes.