Interaction effects of perinatal stress and quality of family environment are reported for a multiracial cohort of 660 children born on the island of Kauai and followed from the prenatal period to age 18. Antecedents and consequences of childhood mental health problems and learning disabilities illustrate the relationship between social class and vulnerability, the likelihood of persistence of childhood disorders with strong biological and temperamental underpinnings, the pervasive effects of quality of early caretaker-child transactions, the importance of an internal locus of control and communication skills in coping with emotional and academic problems, and the resiliency of most children.