Introduction: Long-term survival in pediatric intestinal failure (IF) has improved over recent decades due to medical/surgical advances and the development of multi-disciplinary rehabilitation programs. Focus has shifted towards identifying neurodevelopmental morbidities and promoting optimal quality of life. There has been little exploration into social-emotional and adaptive functioning. Methods: Children (4-18 years) in our IF rehabilitation program underwent neuropsychological assessments (2012-2019) which included caregiver- and teacher-reported social-emotional (BRIEF/BRIEF-2, BASC-2/BASC-3) and adaptive (ABAS-II/ABAS-3, SIB-R, Vineland-II, BASC-2/BASC-3) functioning questionnaires. Results were compared to age-matched norms (mean=100; SD=15) using one-sample z-tests. Medical variables showing ≥3 significant correlations with social-emotional and adaptive functioning outcomes were included in linear regression analyses to explore medical factors independently associated with psychological outcomes. Results: Overall, 74 children (55% males) underwent assessments (median assessment age: 6.5 years, IQR:6.1-8.1). Most children (72%) were premature (median gestational age [GA]: 34 weeks, IQR:29-37; median birth weight [BW]: 2.1kg, IQR:1.1-2.6). The most frequent IF etiology was necrotizing enterocolitis (NEC; 32%). Although caregiver- and teacher-report indicated broadly average-range mean scores, given the standard deviations, the group performed significantly poorer than age-matched norms on executive functioning, internalizing emotional problems (i.e., anxiety, depression, somatization), and adaptive functioning (Figure). GA, NEC diagnosis, duration of first year hospitalization, and total ambulatory clinic appointments correlated with ≥3 social-emotional and adaptive functioning outcomes while BW, small and large bowel length, total septic episodes, and total parenteral nutrition days did not. In the regression, adjusted for GA, NEC diagnosis predicted internalizing emotional problems. Duration of first year hospitalization and total ambulatory clinic appointments were both non-significant. Conclusions: Relative to population norms, the group displayed executive dysfunctions, emotional issues, and poor adaptive functioning. NEC diagnosis and GA, rather than IF related factors, posed heightened risk for emotional issues. Future research should explore demographic risk factors to further inform clinical screening and targeted intervention.Figure.: Social-Emotional and Adaptive Functioning in School-Age Pediatric Intestinal Failure Compared to Age-Matched Population Norms.