The development and implementation of the cochlear implant (CI) is a highly significant advance in treating hearing loss (HL) in children. However, there is a time lag between early identification of HL and the age at which the CI can feasibly be completed, often at least six months and usually longer. This lag, during which children do not have access to auditory linguistic input, occurs during a sensitive period of prelinguistic communication development (Ruben & Schwartz, 1999). Many children with CIs exhibit long-term language outcomes inferior to their peers with normal hearing (Belzer & Seal, 2009) and the prelinguistic period may be an important time for optimizing long-term outcomes. To date, few studies have examined effective communication interventions for children with HL. The objective of the proposed study is to evaluate the effects of systematically teaching parents to use communication support strategies on pre-implantation preliguistic communication and post-implantation spoken language skills. The central hypothesis is: (a) that parental use of visual, tactile, responsive, and interactive communication support strategies during the critical period of preliguistic development between HL identification and implantation will be associated with greater child communication skills before as well as after implantation, and (b) that systematic parent training will result in greater use of these strategies. The rationale for the proposed stud is to provide preliminary evidence regarding effective pre-implantation communication treatment (PICT) strategies that subsequently may be tested on a larger scale. The specific aims include: (a) determining which communication support strategies used prior to implantation predict pre-implantation prelinguistic communication and post-implantation spoken language skills, (b) comparing parental use of communication support strategies between PICT and control groups, and (c) comparing growth in prelinguistic communication and spoken language between groups. The proposed study will enroll 30 children with severe-to-profound, bilateral, congenital, sensorineural HL who receive CIs before 24 months. Children will be randomly assigned to either PICT or a control group. Children in both groups will be assessed: (a) at the start of the study, (b) 1 week prior to implantation, (c) 6 months and (d) 12 months following implantation. Children in the PICT group will receive 6-months of intervention that: (a) is delivered during the lag time between identification of HL and implantation - an important period of language development, (b) incorporates visual, tactile, responsive and interactive communication support strategies that are associated with stronger language skills; and (c) includes systematic parent training found to be effective in teaching parents to use communication support skills in other populations of children. The proposed research is significant, because it is expected to apply, adapt and test communication strategies found to be effective in other populations of children, thereby advancing the field of language development in children with HL, where there is a striking paucity of communication intervention research. PUBLIC HEALTH RELEVANCE: Improving the language outcomes of children with cochlear implants has important public health implications. The proposed research is a small, randomized controlled trial that examines the effects of a parent-implemented, pre-implantation communication intervention on the spoken language skills of 30 children with cochlear implants. Evaluating effective intervention strategies for children with hearing loss supports NIDCD's mission of behavioral research aimed to remediate the disordered process of language development in children with hearing loss.