Background: Children with acquired brain injury (ABI) often present with functional deficits that influence their societal participation and well-being. Successful reintegration into school calls for individual support to meet each child’s adjustment needs. The adjustment needs of children with ABI in school settings have not previously been explored.

Aim: The objectives of the present study were (a) to describe adjustment needs in school settings for children with ABI and (b) to explore differences and similarities between reports from the children and their teachers.

Methods: In this cross-sectional study, 20 children with ABI (mean age 12.8 ± 3.4 years; class grade 1–10) and their teachers were interviewed individually, using the School Setting Interview (SSI). Data were analyzed with descriptive and with non-parametric statistics.

Results: (a) In the overall group, children rated that 55.6% of the 16 activities in the SSI needed no adjustment. The corresponding percentage for teachers was 48.4%. (b) In the child-teacher pairs, there was a positive relationship between teachers’ and children’s responses only in 3 out of 16 school activities and agreement varied strongly according to the activity in question.

Conclusions and significance: It is important for occupational therapists and other professionals to specifically consider adjustment needs relating to school activities from various perspectives when aiming to provide individualized interventions.