The aim of this study was to extend the literature on cognitive and psychosocial adjustment and on facial processing in children with Prenatal Alcohol Exposure (PAE). Twenty-five children with PAE, 23 neurotypical children, and 13 children with Down syndrome matched on sex and mental age participated. Parents or guardians completed the Conners Comprehensive Behavior Rating Scale for Parents and the Social Responsiveness Scale; participants completed facial processing tasks. Using MANOVAs, the PAE group had substantially higher standard scores on all CBRS-P and SRS subscales compared with the typical group, and on almost all of them compared with the Down syndrome group. A large portion of individuals in the PAE group had clinically significant scores on the CBRS-P subscales, including ADHD, conduct and oppositional/defiant disorder, autism spectrum disorder, major depression, manic episodes, generalized and separation anxiety and phobias. Using a MANCOVA, no group differences were found in facial processing between the PAE and the neurotypical groups. Many children with PAE had scores that exceeded cut-offs for autism spectrum disorders, ADHD, conduct disorder, oppositional/defiant disorder, major depression, manic episodes, generalized and separation anxiety, and phobias. In addition, academic, language and mathematics problems were noted relative to typical children. Finally, children with PAE performed just as well on the facial processing tasks as a group of younger typical children of equal mental age. That means that facial processing by children with PAE was corresponded with their mental age.