Introduction. Limited information is available concerning psychosocial adjustment in children who have suffered a stroke and no research to date has explored potential risk factors. This study aimed to i) compare social competence in children with stroke to those with a chronic illness (asthma) and healthy controls; and ii) investigate the relationship of stroke pathology and environmental influences to social competence. Method. Thirty-six children with arterial ischemic stroke (AIS) at least 12 months prior to participation were recruited and compared to two matched control groups: chronic illness (asthma) controls (n=15) and healthy controls (n=43). Children with AIS underwent MRI scan (coded for volume and location) and neurological evaluation. All children had an intellectual assessment and children and parents completed questionnaires to assess social competence. Results. Children with AIS demonstrated poorer social competence compared to healthy controls, and parents of children with stroke reported more social problems than did parents of healthy and chronic illness controls. Within the stroke sample, lesion volume was not associated with social outcome, but discrete subcortical stroke was related to reduced social participation and younger age at stroke onset predicted better social interaction and higher self-esteem. Family function predicted social adjustment. Conclusions. Findings highlight the risk of social impairment following pediatric stroke, with both stroke-related and environmental factors influencing children’s social competence in the chronic stages of recovery, They indicate the potential for intervention which focuses on support at the family level.