Background Very preterm (VPT; <30 weeks gestation) children are a heterogeneous group, yet the co‐occurrence of psychiatric and neurodevelopmental impairments remains unclear. Moreover, the clinical and socio‐environmental factors that promote resilient developmental outcomes among VPT children are poorly understood. Methods One hundred and twenty five children (85 VPT and 40 full‐term) underwent neurodevelopmental evaluation at age 5‐years. Parents and teachers completed measures of internalizing, externalizing, attention‐deficit/hyperactivity (ADHD), and autism symptoms. Psychiatric and neurodevelopmental measures were analyzed using Latent Profile Analysis. Multinomial regression examined the extent that infant, sociodemographic, and family factors, collected prospectively from birth to follow‐up, independently differentiated resilient and impaired children. Results Four latent profiles were identified, including a Typically Developing Group which represented 27.1% of the VPT group and 65.0% of the full‐term group, an At‐Risk Group with mild psychiatric and neurodevelopmental problems (VPT 44.7%, full‐term 22.5%), a Psychiatric Group with moderate‐to‐severe psychiatric ratings (VPT 12.9%, full‐term 10.0%), and a school‐based Inattentive/Hyperactive Group (VPT 15.3%, full‐term 2.5%). Clinical diagnoses were highest among the Psychiatric Group (80%). Factors that differentiated resilient and impaired subgroups of VPT children included prolonged exposure to maternal psychosocial distress (p ≤ .04), current family dysfunction (p ≤ .05), and maternal ADHD symptoms (p ≤ .02), whereas social risk index scores differentiated resilient and impaired full‐term children (p < .03). Conclusions Lower levels of maternal distress, family dysfunction, and maternal ADHD symptoms were associated with resilience among VPT children. Maternal distress and family dysfunction are modifiable factors to be targeted as part of psychiatric interventions embedded in the long‐term care of VPT children.