This study aimed to examine the role of coping strategy use in concurrent and later adjustment in adolescents with craniofacial anomalies (CFAs). It was expected that better adjustment at both baseline and 12 months would be related to greater baseline perceived coping efficacy, greater use of active coping and social support seeking, and less use of avoidance strategies. Eighty adolescents with CFAs and their parents completed measures of adjustment, coping strategy use, and efficacy in response to CFA-related stressful situations. Fifty-five families completed these measures again 12 months later. Overall, the predicted pattern of correlations between coping and adjustment was found. However, coping and efficacy at baseline did not explain a significant proportion of the variance in adjustment measures 1 year later, after controlling for baseline adjustment. Such prospective findings are beginning to bring into question the assumed importance of coping in pediatric adjustment.