This paper reviews research on the consequences of prenatal exposure to alcohol and cocaine on children's speech, language, hearing, and cognitive development. The review shows that cognitive impairment, learning disabilities, and behavioral disorders are the central nervous system manifestations of fetal alcohol syndrome (FAS), and cranio-facial abnormalities are also present. Delays in language acquisition, as well as receptive and expressive language deficits, are commonly reported. The cranio-facial abnormalities of FAS, which sometimes include cleft palate, make the child prone to otitis media with effusion and conductive hearing loss. The family environment in which one or both parents is a heavy alcohol user presents challenges to a child with normal intelligence, but may be especially deleterious to the child with mental retardation. Prenatal exposure to cocaine results in subtle cognitive disabilities when measured at 4 years of age. The cognitive effects may be ameliorated by a stimulating and sensitive care-giving environment. A small, deleterious "cocaine-effect" is also seen in speech and language development. The child with prenatal exposure to cocaine may be considered at increased risk for language delay or disorder. There is no evidence that prenatal cocaine exposure by itself is a risk factor for sensorineural hearing impairment, although auditory evoked potentials from the brainstem and cortex suggest some abnormalities in central auditory processing, at least during the newborn period. The strong effect of the home environment for ameliorating the effects of prenatal cocaine-exposure suggests that a family-focused approach for cognitive, language, and social-emotional habilitation would be beneficial to all. Learning outcomes: The learner will be able to describe the major features of fetal alcohol syndrome and how they relate to speech, language, hearing, and cognitive disorders. The learner will review the literature and determine research needs with respect to language, speech, and hearing among infants and children with fetal alcohol syndrome. Similarly, the learner will distinguish the outcomes of prenatal alcohol-exposure from those of prenatal cocaine-exposure. The learner will summarize the controversy regarding the possible stigmatization of cocaine-exposed infants. The learner will summarize the speech, language, and hearing effects of prenatal cocaine-exposure.