Speech, language, and learning problems are among the most common characteristics of velo-cardio-facial syndrome (VCFS). This chapter describes the current understandings of speech and language patterns and best treatment practices for individuals with VCFS. Many of the voice and resonance characteristics prevalent in VCFS may be attributed to morphologic and physiologic features of the syndrome. Disorders of vocal pitch in VCFS are not easily treated therapeutically, especially when caused by a morphological deviation. Speech pathologists use a variety of procedures to treat disorders of vocal quality, depending on the cause of hoarseness. Individuals with VCFS may also have a disorder of oral resonance referred to as "potato-in-the-mouth" or "marshmallow-mouth" resonance. Children with VCFS may have four different classes of articulation errors: developmental, phonological, obligatory, or compensatory. Articulation therapy is effective in eliminating compensatory articulation disorders in children with VCFS. However, treatment must be intensive, frequent, individual, concrete, and highly organized.