Internalizing problems are common mental health concerns among children and youth. Identifying malleable risk factors that are associated with internalizing problems, such as not having a trusted adult at school, can lead to positive behavior supports to reduce student risk. The purpose of this study was to evaluate the association between student-reported internalizing problems and having an adult to talk to at school. Students in elementary, middle, and high school (N = 13,881) in the Midwestern United States provided self-report data about their internalizing symptoms and whether they had an adult to talk to at school if they had a problem. Participants were 51% male and 72% White; 40% qualified for free or reduced lunch and 12% were in special education. A series of growth models revealed that not having a trusted adult at school was a strong risk factor for internalizing symptoms over the school year. Moreover, lack of a trusted adult was associated with worsening internalizing symptoms over time for middle and high school students. The findings have implications for identifying students and planning supports to alleviate this risk.