Bimodal bilingual (spoken and sign language) programming has been recommended to promote the language and social development of deaf and hard of hearing (DHH) students as advances in auditory technologies and inclusion placements have opened up opportunities for access to spoken language (Mitchiner et al., 2012). The authors report preliminary findings of a small-scale, service-oriented bimodal bilingual (Macau Sign Language and spoken Cantonese) project at a deaf service center with four preschool deaf children who had underlying neurological conditions. Using a qualitative multiple case study design, the authors document yearlong language and social growth along with caregiver and administrator commentary. Recommendations are made for future empirical studies investigating bimodal bilingual programming in Macau and other Asian jurisdictions with deaf residents.