This paper reviews the common adaptational disturbances of children and adolescents with cystic fibrosis at a major treatment center. Common presenting problems included learning disturbances, problems of behavioral control, somatic symptoms, anxiety, and depression. These disturbances, which often reflected maladaptive family adaptation to the stresses of the disease, posed difficult diagnostic dilemmas and necessitated a range of mental health and consultation services. The implications of these findings for mental health professionals who work with chronically ill children and their families are reviewed.