Three studies compared 98 children with spina bifida myelomeningocele (SBM)—a disorder associated with high rates of math disability and spatial deficits—to 94 typically developing children on multidigit subtraction and cognitive addition tasks. Children with SBM were classified into those with reading decoding and math disability, only math disability, and no reading or math disability. Study 1 showed that visual—spatial errors in multidigit arithmetic were not elevated in children with SBM. In Study 2, deficits in accuracy, speed, and strategy-use in single-digit addition characterized groups with math disability regardless of reading status. Accuracy and speed on single-digit addition was strongly related to performance on multidigit subtraction. A math-level matching design in Study 3 revealed less mastery of math facts by the group with SBM. The results are discussed with reference to cognitive and neuropsychological models of math disability.