Objective To examine childhood aggression at age 5 in a multiple risk model that includes cocaine exposure, environmental risk, and gender as predictors. Methods Aggression was assessed in 206 children by using multiple methods including teacher report, parent report, child's response to hypothetical provocations, and child's observed behavior. Also examined was a composite score that reflected high aggression across contexts. Results Multiple regression analyses indicated that a significant amount of variance in each of the aggression measures and the composite was explained by the predictors. The variables that were independently related differed depending on the outcome. Cocaine exposure, gender, and environmental risk were all related to the composite aggression score. Conclusions Cocaine exposure, being male, and a high-risk environment were all predictive of aggressive behavior at 5 years. It is this group of exposed boys at high environmental risk that is most likely to show continued aggression over time.