Two intervention approaches designed to address the multifaceted academic and cognitive difficulties of low-income children who enter pre-K with very low math knowledge were tested in a randomized experiment. Blocking on classroom, children who met screening criteria were assigned to a Math + Attention condition in which the Pre-Kindergarten Mathematics Tutorial (PKMT) intervention was implemented (4 days/week for 24 weeks) in addition to 16 adaptive attention training sessions, a Math-Only condition using the PKMT intervention, or a business-as-usual condition. Five hundred eighteen children were assessed at pretest and posttest. There was a significant effect of the PKMT intervention on a broad measure of informal mathematical knowledge and a small but significant effect on a measure of numerical knowledge. Attention training was associated with small effects on attention, but did not provide additional benefit for mathematics. A main effect of state on math outcomes was associated with a stronger, numeracy-focused Tier 1 mathematics curriculum in one state. Findings are discussed with respect to increasing intensity of math-specific and domain-general interventions for young children at risk for mathematical learning difficulties.