Objective: The role of seizure-related factors and psychopathology on neurocognitive functioning has been extensively studied throughout the literature. The present study, however, is among the first to examine the multiple etiological determinants of neuropsychological dysfunction in pediatric epilepsy by assessing the individual and combined explanatory power of psychiatric status, behavior, social skills, and seizure-related factors. Method: Sixty participants, ranging in age from 6–17 years, all with confirmed diagnoses of epilepsy and FSIQs > 70 were included. A test battery assessing general intellectual, language, visuospatial, attentional, executive, learning and memory-related abilities was administered. Two parent-report questionnaires (the CBCL and the BASC-2) were also completed. Results: Ratings on global measures of psychiatric and behavioral symptomatology significantly contributed to diminished language abilities (p ≤ .05) after seizure variables were accounted for; seizure type and treatment regimen both significantly moderated this relationship. Elevated levels of depression, anxiety and somatization contributed to language deficits and learning and memory impairment (p ≤ .01); treatment regimen emerged as a consistent performance moderator (p ≤ .01). Externalizing behaviors, as assessed via the BASC-2, was the most robust measure of group difference with respect to neurocognitive performance, significantly contributing to performance in the domains of executive functioning (p ≤ .01), language (p ≤ .05), and learning and memory (p ≤ .05). Conclusion(s): Study data identified several subgroups of children with epilepsy at increased risk for neuropsychological dysfunction. To this end, frequent assessment, psychoeducation, psychotherapy and/or cognitive remediation may be warranted.