Prenatal alcohol exposure results in permanent damage to the central nervous system, leading to language and communication deficits that are characteristic of fetal alcohol spectrum disorders (FASD). The aim of this review article is to present current knowledge on communication difficulties and verbal fluency disorders in children with FASD, with particular emphasis on their diagnostic significance. The paper is based on a review of recent literature concerning the neurobiological basis of communication impairments, language functioning, and verbal fluency performance in children prenatally exposed to alcohol. The reviewed studies indicate that central nervous system damage contributes to deficits in discourse organisation, comprehension of non-literal language, prosody, and the generation of words according to phonemic and semantic categories. The literature also demonstrates that verbal fluency assessment provides valuable information about a child's cognitive functioning and may be an important component of a comprehensive, multidisciplinary FASD assessment. The findings highlight the need to incorporate systematic evaluation of language and communication abilities into both the diagnostic process and therapeutic planning for children with FASD.