Children typically record dramatic growth in reading skills in primary school. This is not surprising since reading instruction has been placed at the heart of primary school curricula. Irrespective of country, learning outcomes in primary schools everywhere articulate the expectation that children will read, comprehend, and write to express themselves well. This chapter focuses on children who fall behind these stated literacy expectations within their school system, arguing that, while some will qualify for the diagnosis of dyslexia, all those who struggle will need a measured response from the primary school system. A cursory look at the decision-making framework that primary schools follow for those who fall behind shows variation across countries and also within countries, including those that have a well-articulated protocol of referral and response. Given this, it is useful to think of school systems as placed at different points on a continuum of support, with schools that have no discernable provisions and schools with multilayered provisions put at either extreme. This variety may reflect differences in access to resources for screening, diagnostic testing, and tiers of targeted interventions.