This review examined the effectiveness of critical factors in instruction for improving the reading comprehension of middle school students with learning disabilities. Five critical factors were identified: (i) type of instructional methods, (ii) self-monitoring, (iii) components of reading incorporated, (iv) fidelity of instruction (scripted vs. nonscripted and researcher vs. teacher), and (v) group size. Fourteen studies published between 1990 and 2010 were reviewed. The findings indicated that interventions incorporating strategy instruction, specifically, main idea and summarization, yielded high effects on comprehension. The use of self-monitoring combined with main idea strategy improved comprehension performance. It was found that both, instruction targeting comprehension alone, as well as comprehension that incorporated other reading components such as vocabulary had significant effects on comprehension. Researcher-delivered instruction with script yielded higher effects across intervention types. One-on-one instruction or instruction in pairs was more effective than large group instruction across intervention types.