Theory of mind plays an important role in our everyday interpretation of interactions. Being able to analyze what people desire, know, and believe and recognizing these mental aspects may be false or different from our own is a key component of language, cognitive, and social development. Studies have shown that skills that fall under theory of mind (ToM) such as recognizing diverse beliefs, knowledge access, social pretend, and false beliefs typically develop during preschool age (Wellman & Liu 2004, Peterson & Wellman 2009). Specifically, false belief has been investigated the most and shows a distinct pattern of being more difficult for hearing three-year olds to understand, but not five-year olds. Within this body of literature, the influence of language and hearing ability have also been studied as key factors in how ToM develops in hearing children. However, children with hearing loss (DHH) represent a diverse population that are affected by even more aspects of environmental influences. Many studies have looked at small groups of DHH children who have hearing parents and some have compared them to deaf children of deaf parents. The present study involves 351 elementary-age children with hearing loss from across the USA. These students have diverse hearing abilities and different levels of access to spoken language and sign language. These children were given theory of mind tasks that include false belief, knowledge access, and social pretend. We explore the influence of language abilities, parental hearing status, amount of growth in a school year, access to language through audition, and communication modality. Through confirmatory factor analysis and structural equation modeling, we find that language abilities predict theory of mind, above and beyond all other factors. This information can be used clinically to help target students who may be at risk for delayed theory of mind and help to establish interventions to reverse or prevent delays. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]