Children born at very low birth weights (VLBW) (less than or equal to 1500 g) who were beneficiaries of modern neonatal intensive care are reaching middle childhood, and their school achievement can be evaluated. We compared 65 9-year-old children born in 1976, who were very low birth weight and who were free of neurological impairment, with 65 children of normal birth weight who had been matched for race, sex, age, and social class on measures of IQ, cognitive, visuo-motor, and fine motor abilities, and academic achievement. VLBW children scored significantly lower than controls on the WISC-R, Bender-Gestalt, Purdue Pegboard, subtests from the Woodcock Johnson Cognitive Abilities Battery, and reading and mathematics (math) achievement. Exploratory analysis of a subset of 43 VLBW and matched controls with IQ scores greater than or equal to 85 yielded a similar trend, except that, on achievement tests, differences were significant only in math. Further analyses revealed that the differential in math achievement between VLBW and control children is not fully attributable to differences in IQ.