Prospective, longitudinal follow-up of academic status following pediatric traumatic brain injury (TBI) identified that patients with severe TBI (n = 33) obtained significantly lower reading recognition, spelling, and arithmetic scores than those with mild to moderate TBI (n = 28). Independent of injury severity, adolescents scored lower than children on computational arithmetic and reading comprehension subtests. Although all achievement scores increased significantly from the baseline evaluation to 6 months after the injury, no further change was noted from 6 months to 2 years. Despite average achievement test scores by 2 years after TBI, 79% of the severely injured patients had either failed a grade or received special educational assistance. Traditional achievement tests may be insensitive to posttraumatic academic deficits.