A sample of children from Spanish-speaking homes who are hard-of-hearing demonstrated less than optimal outcomes following cochlear implantation. The authors developed a unique diagnostic protocol to identify potential causes. Inclusion criteria included hearing loss identified by 3 months of age, amplification, a Spanish-speaking home, and enrollment in the statewide early intervention system by 6-months of age. The authors collected extensive demographic data from participants, and the participants completed the same language assessments in 6-month time intervals, examining receptive and expressive language as well as parent-child interaction. Additional assessments included cortical auditory-evoked potentials (i.e., P1), infant speech perception, auditory skill questionnaires, and audio recordings taken over a 12–16 hour period in the child's natural language environment. This auditory spoken language matrix allowed identification of good auditory performers who performed poorly on expressive language measures and poor auditory performers with poor expressive and receptive language outcomes. The comprehensive nature of the assessment allowed examination of spoken language input and helped determine if poor language outcomes were associated with a lack of spoken language input (Hart & Risely, 1995). This matrix allowed the authors to rule out audibility, discrimination, auditory development, and quality of exposure to auditory spoken language as causes of delayed development. The article discusses additional benefits of using this protocol.