The purpose of this study was to identify emotional, behavioral, and academic co-occurring risk profiles of third-grade youth and to understand how they are longitudinally associated with later outcomes in sixth grade. The latent profile analysis of data from a U.S. Midwest community sample of 1,785 third graders resulted in five classes of risk profiles: No Risk (47%), Low Risk (36%), High Internalizing and Emotion Dysregulation (8%), High Externalizing (7%), and Co-occurring Risk (2%). The Co-occurring class had significantly worse outcomes on all sixth-grade measures compared to other classes. The High Internalizing and Emotion Dysregulation class had significantly higher internalizing problems but also higher externalizing problems. Youth with predominant externalizing features continued to evidence these problems in sixth grade, along with a high number of office discipline referrals, in-school suspensions, and out-school suspensions. Students with co-occurring social, emotional, behavioral, and academic issues are at increased risk of future challenges. Schools can use comprehensive and systematic screening to identify students with co-occurring problems. The study highlights the importance of early identification through screening and taking into consideration the co-occurring presentation of symptoms.