Background Information: Sarah was born at 39 weeks gestation. Her parents reported typical prenatal and early childhood development. She met developmental milestones within expected timeframes. She has a history of middle ear infections between the ages of 2 and 5. Since birth, Sarah has been social and has made friends easily. She received speech and language services for articulation difficulties (lateral lisp) beginning when she was 6. She made progress with articulation, and treatment was discontinued when she was 8. Sarah’s mother reported that, at times, Sarah mispronounces words. Specifically, she transposes phonemes (i.e., says “aminal” for “animal” and “ephelant” for “elephant.”) Sarah’s mother also reported that Sarah likes to memorize books and “read” them out loud to people. In second grade, Sarah’s parents and teacher noticed that Sarah demonstrated difficulty decoding and reading fluently. Despite support through Response to Intervention, Sarah was not making adequate progress. Sarah was referred for an evaluation for special education. Results of speech and language testing revealed articulation skills within normal limits. Her receptive and expressive language skills were also in the average range. She was able to produce a well-sequenced, organized oral narrative that included appropriate story elements. Her conversational skills were also judged to be good. Sarah performed significantly below the average range in phonological awareness. Results of achievement testing revealed that Sarah had normal sight word vocabulary. She had below average scores in her ability to apply phonics and structural analysis skills to decode nonsense words. Her reading rate and fluency were also significantly below average. Her spelling skills were below average; she demonstrated multiple spelling errors in a written narrative and used incorrect capitalization and punctuation. Throughout third grade, Sarah participated in a mainstream classroom with special education support. Sarah is now in fourth grade in a mainstream classroom and continues to receive the same services. Her teachers have noted that she is making progress but continues to read two years below grade level. In addition, her teachers have noted that her reading difficulty affects her performance in math,