Co-occurring social-emotional problems are associated with increased risk of aggression and substance use. However, few studies examine their configurational patterns. This study identifies patterns of co-occurring social skills, anxiety, learning, and conduct problems among 2,632 urban boys at entry into sixth grade, and their related aggression and substance use trajectories through eighth grade. Latent class analysis revealed four patterns at school entry: "low-all," "poor social skills," "positive social skills," and "high all." Findings point to important variation in risk. Problem behaviors increased the least through middle school for the "low-all" pattern. The "positive social skills" pattern had an average increase, while the "poor social skills" pattern had higher levels of problem behaviors in sixth and seventh grade. The "high all" showed the fastest increase in problem behaviors and the highest levels in eighth grade. Discussion focuses on implications for a multi-tiered school-based system of supports for behavioral risk management.