Background <p>Summer care programs provide important developmental contexts for adolescents, yet little is known about how psychological distress influences peer dynamics in these settings. Previous research has shown that mental health symptoms can affect social integration in school environments, but these patterns may differ in summer programs.</p> Objective <p>This study aimed to examine the relationship between adolescent psychological distress and friendship network dynamics in a summer care program over time.</p> Methods <p>Adolescents (n=47, ages 10-14) attending an 8-week summer program completed surveys at the start and end of the program, assessing friendships, negative interactions, and psychological distress. Exponential random graph modeling (ERGM) and separable temporal exponential random graph modeling (STERGM) were used to analyze friendship networks and their changes over time.</p> Results <p>Adolescents with higher psychological distress were more likely to receive friendship nominations but less likely to initiate them at the end of summer. Friendships were more likely to form between adolescents similar in age and gender. Over time, adolescents with higher psychological distress scores were more likely to receive friendship nominations but also more likely to be nominated as someone others did not get along with.</p> Conclusions <p>Psychological distress influences adolescents' social positions in summer program networks, with distressed youth receiving more friendship nominations but also experiencing more negative interactions. These findings highlight the complex social dynamics faced by adolescents with mental health symptoms in summer care settings and underscore the importance of monitoring social integration patterns to support all participants' well-being. </p>