Objectives We aimed to (i) evaluate psychological distress in adolescent survivors of childhood cancer and compare them to siblings and a norm population; (ii) compare the severity of distress of distressed survivors and siblings with that of psychotherapy patients; and (iii) determine risk factors for psychological distress in survivors. Methods We sent a questionnaire to all childhood cancer survivors aged <16 years when diagnosed, who had survived ≥5 years and were aged 16–19 years at the time of study. Our control groups were same‐aged siblings, a norm population, and psychotherapy patients. Psychological distress was measured with the Brief Symptom Inventory‐18 (BSI‐18) assessing somatization, depression, anxiety, and a global severity index (GSI). Participants with a T‐score ≥57 were defined as distressed. We used logistic regression to determine risk factors. Results We evaluated the BSI‐18 in 407 survivors and 102 siblings. Fifty‐two survivors (13%) and 11 siblings (11%) had scores above the distress threshold (T ≥ 57). Distressed survivors scored significantly higher in somatization (p = 0.027) and GSI (p = 0.016) than distressed siblings, and also scored higher in somatization (p ≤ 0.001) and anxiety (p = 0.002) than psychotherapy patients. In the multivariable regression, psychological distress was associated with female sex, self‐reported late effects, and low perceived parental support. Conclusions The majority of survivors did not report psychological distress. However, the severity of distress of distressed survivors exceeded that of distressed siblings and psychotherapy patients. Systematic psychological follow‐up can help to identify survivors at risk and support them during the challenging period of adolescence. Copyright © 2013 John Wiley & Sons, Ltd.