This qualitative study framed in the Simple View of Reading (Gough & Tunmer, 1986; Hoover & Gough, 1990) examined similarities and differences between students labeled struggling readers and those labeled students with or at risk for dyslexia. The study utilized document analysis to analyze the clinical reading intervention files of 44 students, kindergarten through grade 3, from two afterschool literacy clinics, an urban, community-based clinic and a suburban, private clinic. Document analysis of the files of 21 students with or at risk for dyslexia and 23 struggling readers provided data for thematic analysis of the labels used to describe readers in need of clinical intervention and comparative content analysis of the reasons parents sought clinical reading intervention, reading comprehension levels, language comprehension levels, phonological awareness skills, decoding skills (including sight word recognition, decoding, and fluency), and encoding skills. Content analysis of parent responses to multiple-choice prompts found all parents sought clinical reading intervention because of their children’s struggles with decoding. In addition, one-quarter sought support for comprehension. Thematic analysis of open-ended prompts revealed three themes: concern about children’s academic decline despite their effort to learn and the parents’ effort to support them; concerns about children’s mental health; and, concerns about children’s deteriorating attitudes toward reading. Content analysis of assessment data, clinician notes, and parent and teacher comments indicated a number of similarities in the patterns in the reading behaviors of struggling readers and dyslexic readers. These patterns were evident in both factors that affect reading comprehension, namely linguistic comprehension and word recognition skills. There were identifiable differences that distinguished dyslexic readers from struggling readers in the areas of phonemic awareness and spelling errors. The findings of this research study amplify the importance of using a universal screener in kindergarten and first grade to identify at-risk students. Findings suggest implications for professional development for kindergarten to grade 3 teachers on several topics. Also, findings suggest future research on the combination of the students’ phoneme segmentation deficiencies coupled with their encoding errors is important to understand differences between dyslexic and struggling readers.