According to interpretations of results from the latest oral reading fluency (ORF) study conducted by the National Assessment of Educational Progress (White et al., 2020), fourth-grade students who score below the basic standard require interventions that focus on word recognition, phonological decoding, and fluency. Before such mandates for students at the middle grades and beyond are enacted, the available information from ORF assessments should be examined from the view of what students know and what they do not know. In this paper, I examine the performances of students who score below the basic level on oral reading assessments such as those used in the NAEP/ORF study to identify students' strengths and challenges. Results of analyses of students' performances are used to address how instruction and interventions can best support students in developing the proficiencies required to perform successfully on silent reading comprehension tasks. Issues that particularly require attention in the design of instruction and interventions for readers in the middle grades who score below the basic level are the mode of reading (silent or oral), text, and reading volume.