This paper examines data on peer relations and adjustment change among students with chronic physical conditions as they make the transition from Year 6 to Year 7. This analysis of change, emerging from a longitudinal investigation, considers patterns of stability, decline or growth in peer relationships, and the ensuing impact of such developments on the social self-perceptions of the individual. Self-reports from 24 young adolescents are supplemented with data from peer reports of acceptance and friendship at both the Year 6 and Year 7 time-points. While findings are generally illustrative of positive student adjustment across the transition to high school, such positive cases of peer relationship growth can be contrasted against specific cases of students experiencing peer rejection. Differential peer outcomes are considered in light of both social self-perceptions data and student reports of their social experience in the school environment. These findings are discussed within a framework that considers the need to highlight positive adjustment processes and the value of this knowledge for future research and intervention.