Abstract Background Preterm children are at risk for behavioral and emotional problems. Aims To evaluate behavior and emotional well-being of extremely low birth weight (ELBW) teenagers born in Iceland in 1991–1995. Methods Participants, 30 of 35 ELBW survivors (25 girls, 5 boys, mean age 16.8years), were interviewed, underwent medical examination and answered the Youth Self-Report for ages 11–18 (YSR) of the Achenbach System of Empirically Based Assessment (ASEBA). The ELBW parents answered the ASEBA Child Behavior Checklist for ages 6–18 and the Autism Spectrum Screening Questionnaire (ASSQ). A comparison group of 30 teenagers (23 girls, 7 boys, mean age 16.5years) answered the YSR questionnaire and their parents answered the CBCL and ASSQ questionnaires. Results ELBW teenagers and parents report more behavior problems than the full term comparison teenagers and parents. They score significantly higher on the YSR and CBCL syndrome scales except for YSR and CBCL rule-breaking behavior and CBCL thought problems. The ELBW teenagers self-report on total competence, activities, social participation and academic performance was not significantly lower than the comparison teenagers. Parents of ELBW teenagers rated total competence, social participation and school performance of their children significantly lower than parents of comparison teenagers. The YSR Positive Qualities Scale was not significantly different between the two teenage groups. Two ELBW teenagers scored above cut-off points on the ASSQ questionnaire and none of the comparison teenagers. Bullying was reported by 20% of ELBW parents compared to none of the comparison group. Conclusion ELBW teenagers experience emotional, behavior and social challenges. The teenagers value their positive qualities, activities and academic performance similar to peers.