This study aimed to elucidate the organization and developmental sequences of macro-structure elements in the written narratives of 44 students in Japan, aged 7-11 years and attending the same school, who were deaf or hard of hearing (DHH). A high-point analysis of oral paper puppet play storylines revealed that the students were able to develop and organize narrative macro-structures in a sophisticated manner. In completing the elements of action, sequence, orientation, and climax, students could plan storylines to attract readers and construct the overall flow efficiently to the climax. However, the students had difficulties acquiring resolution and evaluation; in addition, they showed inherent challenges in representing the inner world of narrators or characters and concluding the story. The findings highlight the importance of an intervention program for DHH students to acquire all macro-structure elements based on the development of world experience and social-cognitive skills.