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<strong>Background:</strong> Considerable variability exists in the speech recognition abilities achieved by children with cochlear implants (CIs) due to varying demographic and performance variables including language abilities.

<strong>Purpose:</strong> This article examines the factors associated with speech recognition performance of school-aged children with CIs who were grouped by language ability.

<strong>Research design:</strong> This is a single-center cross-sectional study with repeated measures for subjects across two language groups.

<strong>Study sample:</strong> Participants included two groups of school-aged children, ages 7 to 17 years, who received unilateral or bilateral CIs by 4 years of age. The High Language group (N = 26) had age-appropriate spoken-language abilities, and the Low Language group (N = 24) had delays in their spoken-language abilities.

<strong>Data collection and analysis:</strong> Group comparisons were conducted to examine the impact of demographic characteristics on word recognition in quiet and sentence recognition in quiet and noise.

<strong>Results:</strong> Speech recognition in quiet and noise was significantly poorer in the Low Language compared with the High Language group. Greater hours of implant use and better adherence to auditory-verbal (AV) therapy appointments were associated with higher speech recognition in quiet and noise.

<strong>Conclusion:</strong> To ensure maximal speech recognition in children with low-language outcomes, professionals should develop strategies to ensure that families support full-time CI use and have the means to consistently attend AV appointments.