Acute stress disorder (ASD) is a fairly common sequela of traumatic exposure, and a significant proportion of those with the disorder go on to develop PTSD. Although neuropsychological deficits soon after trauma exposure have been associated with subsequent PTSD onset, few studies have assessed their association with ASD severity. We sought to investigate neuropsychological predictors of ASD severity in a sample of 128 motor vehicle accident (MVA) survivors, while controlling for potential confounders, such as demographic characteristics, other psychiatric diagnoses, and intelligence. We conducted clinical and neuropsychological assessments approximately 10.3 ± 4.5 days after an MVA. Our findings showed that delayed verbal recall was significantly associated with ASD severity, explaining 12.6% of the variance. However, a large proportion of the variance in ASD severity, 13.6%, was also explained by suicide risk. Effect size of the model was moderate (f(2) = 0.171). Suicide risk and delayed verbal recall appear to be moderately associated with ASD severity after a MVA and may be useful indicators of distress in in acute trauma survivors.