Abstract aObjective The impact of fine motor impairment among adult survivors of childhood acute lymphoblastic leukemia (ALL) on life after treatment is unknown. Methods This study evaluated prevalence and utilized multivariate logistic regression to identify risk factors for fine motor impairment among survivors of ALL, and associations with educational attainment and social independence. Latent class analysis defined social independence (independent, moderately independent, dependent), using employment, independent living, personal care assistance, routine need assistance, driver’s license status, and marital status inputs. Results Among 875 survivors who were ≥ 25 years old (age when most adults achieve independence) and ≥ 5 years from diagnosis (mean = 28.97 years), 33.6% had fine motor impairment, with scores at or below the 10th percentile of the scores of community controls (n = 460) on fine motor components of the physical performance test and the grooved peg-board test. Survivors exposed to cranial radiation had more fine motor impairment than those without (45.8% vs 20.2%). Male sex (exposed: odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.65–3.92; unexposed: OR = 3.02, 95% CI = 1.69–5.38) and lower scores on the Wechsler abbreviated scale of intelligence (exposed: OR = 0.46, 95% CI = 0.36–0.58; unexposed: OR = 0.43, 95% CI = 0.31–0.58) were risk factors for neuropathy. A 1-point-higher total neuropathy score was associated with 8% (95% CI = 1%–17%) increased odds of fine motor impairment. Fine motor impairment was associated with less than a college education (less than high school: OR = 2.23, 95% CI = 1.20–4.14; high school diploma/general equivalency diploma: OR = 2.66, 95% CI = 1.65–4.30; vocational education: OR = 2.07, 95% CI = 1.38–3.13) and less social independence (moderately independent: OR = 1.80, 95% CI = 1.15–2.83; dependent: OR = 2.65, 95% CI = 1.25–5.64). Conclusion Fine motor impairment in survivors of childhood ALL may interfere with optimal educational attainment and social independence. Impact Early identification of survivors at risk for fine motor impairment, with timely intervention, may improve long-term outcomes.