This study investigated the relative effects of three treatments with varying instructional emphases in reading with a comparison condition. Eighty-seven students in fourth grade with reading impairments were assigned through stratified random assignment to one of four conditions: (a) comprehension emphasis, (b) word study emphasis, (c) emphasis of either comprehension or word study based on the student’s pretest reading profile, or (d) school-provided intervention comparison condition. Students in the three researcher-provided treatments received intervention in small groups with a trained tutor for 30 min daily for approximately 28 weeks. Results revealed no statistically significant main effects between conditions on measures of word reading, fluency, vocabulary, or comprehension. Students with limited English proficiency performed significantly better at posttest in all conditions than other students. Discussion addresses the challenges of successfully remediating reading problems with older students with significant reading problems.