Preschool children at familial risk for reading disability were assessed on cognitive and linguistic variables and compared with preschoolers without familial risk. Risk children displayed performance profiles resembling those of older children with reading disability. Each group received intensive instruction in phonemic awareness and structured book reading. Instructed risk children made somewhat smaller gains than the nonrisk and required more teaching sessions to reach criterion. Rhyme and phoneme awareness predicted instruction outcome levels, and vocabulary and verbal short-term memory predicted number of teaching sessions to criterion. In kindergarten, the nonrisk group outperformed the risk group on reading and spelling, although the risk group reached grade-appropriate levels. At-risk children can be helped by appropriate preschool instruction, but they require more sustained teaching than nonrisk preschoolers.