introduction: indigenous youth experience increased rates of psychopathology and school difficulties, compared to non-indigenous peers. literature suggests that psychopathology is associated with school difficulties among youth. cultural engagement has been negatively associated with psychopathology among indigenous youth. the purpose of this study was to investigate the associations between psychopathology (internalizing and externalizing difficulties), cultural difficulties (cultural stress, lack of spirituality/religion as a strength, cultural identity, engaging in rituals) and school difficulties (attendance, achievement, behavior) among first nations youth. it was hypothesized that psychopathology would be positively associated with school difficulties. method: our sample consisted of first nations youth referred to a community-based first nations-led organization between february 2013 and july 2022 who completed the child and adolescent needs and strengths mental health acute (cans-acute) and the child and adolescent needs and strengths mental health (cans-mh). results: internalizing difficulties were strongly correlated with school attendance difficulties, while externalizing difficulties were strongly correlated with school behavior difficulties. both internalizing and externalizing difficulties were correlated with school achievement difficulties. cultural stress was significantly correlated with school attendance difficulties. implications: findings from this study has improved our understanding of the relationships between psychopathology, culture, and school difficulties among first nations youth.