Purpose: To determine if speech error patterns in preschoolers with speech sound disorders (SSDs) predict articulation and phonological awareness (PA) outcomes almost 4 years later. Method: Twenty-five children with histories of preschool SSDs (and normal receptive language) were tested at an average age of 4;6 (years;months) and were followed up at age 8;3. The frequency of occurrence of preschool distortion errors, typical substitution and syllable structure errors, and atypical substitution and syllable structure errors was used to predict later speech sound production, PA, and literacy outcomes. Results: Group averages revealed below-average school-age articulation scores and low-average PA but age-appropriate reading and spelling. Preschool speech error patterns were related to school-age outcomes. Children for whom greater than 10% of their speech sound errors were atypical had lower PA and literacy scores at school age than children who produced less than 10% atypical errors. Preschoolers who produced more distortion errors were likely to have lower school-age articulation scores than preschoolers who produced fewer distortion errors. Conclusion: Different preschool speech error patterns predict different school-age clinical outcomes. Many atypical speech sound errors in preschoolers may be indicative of weak phonological representations, leading to long-term PA weaknesses. Preschoolers' distortions may be resistant to change over time, leading to persisting speech sound production problems. (Contains 4 tables, 2 figures and 1 footnote.)