Objective: The objective was to assess differences in psychosocial adjustment between adolescents with and without craniofacial microsomia (CFM). Design: This is a case-control follow-up study in adolescents with and without CFM. Setting: Participants were originally recruited as infants from 26 cities across the United States and Canada. Participants: Participants included 142 adolescents with CFM (cases) and 316 peers without CFM (controls), their caregivers, and their teachers. Main Outcome Measures: Social and behavior measures from the Achenbach System of Empirically Based Assessments (ASEBA), the PedsQL: Core Version, and the Children’s Communication Checklist–2nd edition (CCC-2) were used. Linear regression was used to estimate case-control differences and corresponding standardized effect sizes (ES) and 95% confidence intervals after adjustment for sociodemographic confounds. We also examined case-control differences by facial phenotype and hearing status. Results: The magnitude and direction of case-control differences varied across assessment and respondent, but were generally modest (ES = –0.4 to 0.02, P values ranged from .003 to .85). There was little evidence for variation in case-control differences across different facial phenotypes or as a function of hearing status. Conclusions: Our results suggest that in spite of multiple risk factors, adolescents with CFM exhibit behavior problems no more frequently than their peers without CFM. Future studies of individuals with CFM should focus on resilience and social coping mechanisms, in addition to maladjustment.