Neurobehavioral outcomes associated with prenatal alcohol exposure range from severe intellectual deficiency to subtle attention and motor deficits. Diagnosis of individuals with fetal alcohol spectrum disorders (FASD) can be challenging especially when physical markers are absent or prenatal histories are unavailable. In addition, due to neurobehavioral similarities, individuals with FASD and those with attention-deficit/hyperactivity disorder (ADHD) can be confused clinically, making differential diagnosis difficult. Research has recommended that identification of FASD be based on a neurobehavioral profile. However, some neurocognitive domains, including decision-making, have received little attention. Emotion-based decision-making involves strategic adaptation of behavior based on uncertain information and is essential for everyday function. Deficits in decision-making in individuals with FASD are suggested by neuroanatomical abnormalities and difficulty with everyday function. The Iowa Gambling Task (IGT) is a widely used measure of decision-making, simulating unpredictable reward and loss contingencies of complex decision-making. The IGT, which has not been used in alcohol-exposed populations, was administered to children with FASD (n = 21), ADHD (n = 22), and typically developing controls (n = 21). Further, because working memory, the process of temporarily storing and manipulating information, may be related to decision-making, a measure of working memory was included in the test battery. A mixed-model ANOVA demonstrated that children with FASD chose significantly fewer advantageous cards than control children. In contrast, children with ADHD were distinguished from controls based on processing frequency of rewards/losses on the IGT. Group decision-making performance was not accounted for by working memory performance in either the FASD or ADHD group. Collectively, these results suggest that children with FASD and ADHD have aberrant decisionmaking processes, although their dysfunction may be due to distinguishable mechanisms. While children with FASD were deficient in making decisions based on learning from exposure to past contingencies, children with ADHD differed from controls in their ability to tolerate unpredictable reinforcement schedules. Decisionmaking was found to be independent of intellectual function and other high order cognitive abilities, including working memory, and therefore should be a consideration in further research and clinical assessment of children with FASD and ADHD.