Project Summary/Abstract: Past research on cochlear implants has been narrowly focused on speech and language outcomes and efficacy of cochlear implantation as a medical treatment for profound hearing loss. As noted in the two earlier NIH consensus statements on cochlear implants, little if any research has investigated the underlying neurobiological and neurocognitive factors that are responsible for the enormous individual differences and variability in the effectiveness of cochlear implants. This proposal requests support for a program of research on the neurocognitive processes underlying speech and language outcomes in prelingually deaf children following cochlear implantation. The primary objective of this research project is to demonstrate that specific domain-general neurocognitive processes related to executive functioning such as working memory, fluency-speed, concentration-inhibition and organization-integration skills are strongly associated with traditional clinical speech and language outcome measures. These processes involve the global coordination, integration and functional connectivity of multiple underlying brain systems used in speech perception, production and spoken language processing. In three related projects, we test the hypothesis that executive function and organization-integration (EOI) processes contribute an additional unique source of variance to speech and language outcomes and benefit above and beyond the conventional demographic, medical and educational factors. The first project uses a cross-sectional design to assess EOI functioning in long term cochlear implant users; the second project uses longitudinal methods to investigate the development of EOI functioning; the third project uses a novel intervention approach to increase working memory capacity and improve speech and language outcomes. These new findings on the underlying sources of variability in spoken language processing will help us understand, explain and predict individual differences in speech and language outcomes following cochlear implantation. The results of this project have direct clinical implications for improving the diagnosis, treatment and early identification of young deaf children who may be at high risk for poor outcomes following cochlear implantation.