Compared to their non-Indigenous peers in out-of-home care (OOHC), children who are Aboriginal are at an increased risk of low academic achievement, mental health problems, and emotional and behavioral symptoms. This study aimed to profile the clinical symptoms experienced and examine the relationships among these clinical symptoms, academic achievement, and early life environmental characteristics, such as maltreatment and placement instability. Data were accessed through a collaborating OOHC clinical service providing support for children who are Aboriginal. Analyses indicated that low academic performance was correlated to clinical symptoms, including anxiety, depression, and somatic issues. Neither academic performance nor clinical symptoms were associated with maltreatment type or exposures. Internalizing clinical symptoms between carers (Child Behavior Checklist, CBCL) and self-report (Youth Self Report, YSR) differed significantly for children 11–18 years. Self-report demonstrated higher levels of internalizing symptoms than the carers reported. The results highlight the importance of capturing the child person’s voice. Future research should investigate the impact of internalizing symptoms on academic performance across education and the impact of informant under-reporting of internalizing symptoms on health, well-being, and diagnostic accuracy.