While many extremely low birth weight (ELBW; <1000g) children experience no lasting developmental sequelae, ELBW is associated with a range of educational deficits, even with satisfactory early development. Can we accurately identify individual children likely to experience academic problems before school entry? In our prospective study of 54 middle-class, ELBW 7 year olds, 41% achieved at or above average in all school subjects. Yet, of the 32(59%) with school problems, only 1/3 (11) were known to be DISABLED (CP, MR, or in early special education) at school entry. A preschool (age 4) test battery including the McCarthy Scales, Beery Visual-Motor Integration and Peabody Picture Vocabulary tests had been administered. Categorization of scores beyond the DISABLED group included children were DELAYED (cognitive score and >2 other scores between 1-2 S.D. below the mean) and DISCREPANT(average cognitive score but any other scores between 1-2 S.D. below the mean). All 37 children in these 3 groups were predicted to have school problems (sensitivity 97%). 6/37 did not have school problems as well as 16/17 children with all average or above preschool test scores (specificity 73%). These data indicate that even mild deficits present at preschool are likely to persist or worsen with school demands. While many do well, pediatricians and parents should ensure that all ELBW children are tested prior to school entry to determine educational needs.