This article addresses questions about instruction for children with severe reading disabilities in 2 ways. First, outcomes from 3 recent studies are examined within the context of a hierarchy of instructional goals derived from current theory about the processes involved in acquisition of reading skill. This analysis suggests that we still have much to learn about effective instruction for children with the most severe reading disabilities. The second part of the article reports preliminary results from a 2½-year prevention project in which 138 children received instruction by 3 different methods. The primary instructional contrast involved the intensity and degree of explicitness of instruction in phonological awareness and phonetic decoding strategies for word reading. Results showed a clear advantage in phonetic reading ability for 1 group of children at the end of the second grade. However, this group did not show corresponding advantages in word-reading vocabulary or reading comprehension. The article concludes with a discussion of weaknesses in current research that suggest questions for future intervention studies.