Here we characterize establishment of joint attention in hearing parent-deaf child dyads and hearing parent-hearing child dyads. Deaf children were candidates for cochlear implantation who had not yet been implanted and who had no exposure to formal manual communication (e.g., American Sign Language). Because many parents whose deaf children go through early cochlear implant surgery do not themselves know a visual language, these dyads do not share a formal communication system based in a common sensory modality prior to the child's implantation. Joint attention episodes were identified during free play between hearing parents and their hearing children (N = 4) and hearing parents and their deaf children (N = 4). Attentional episode types included successful parent-initiated joint attention, unsuccessful parent-initiated joint attention, passive attention, successful child-initiated joint attention, and unsuccessful child-initiated joint attention. Group differences emerged in both successful and unsuccessful parent-initiated attempts at joint attention, parent passive attention, and successful child-initiated attempts at joint attention based on proportion of time spent in each. These findings highlight joint attention as an indicator of early communicative efficacy in parent-child interaction for different child populations. We discuss the active role parents and children play in communication, regardless of their hearing status.