The Program for International Student Assessment (PISA) testing is conducted every 3 years by the Organization for Economic Co-operation and Development (OECD; oecd.org) with 15-year-olds across the globe. Students complete a battery of tests in science, reading, and mathematics and complete an attitudinal survey. The goal of the PISA testing is to determine, broadly, if children are prepared for successful adulthoods. This means that items on the test are application- and not theoretically based. The mathematics portion of the PISA test includes problems in four content subtest areas: (1) change and relationships, (2) quantity, (3) uncertainty and data, and (4) space and shape. The subscale most closely related to spatial cognition is space and shape. Developers of the mathematics portion of the test indicate that student scores on subset areas 1 through 3 also depend on a child's understanding of space and shape; thus, the space and shape construct is a key to overall performance on the test. The goal of this paper is twofold. First, it examines PISA data by subtest for several countries by analyzing trends between high-performing countries and other countries of interest with a particular focus on the subtest scores for space and shape. Second, the paper examines the relationship between scores on individual released items from PISA and scores on standard instruments designed to assess spatial skills for students from the USA. Findings indicate that success on PISA items is significantly correlated with scores on tests of spatial cognition. This finding means that improving spatial skills could be an overlooked strategy to improve student performance on large-scale tests of student achievement and has the potential to ultimately better prepare children for successful adulthoods.