Standardized, large-scale assessment of educational outcomes has become a global phenomenon over the past three decades (Smith, 2016). A key challenge facing assessment designers is that standard formats may be inaccessible or may create barriers to student performance. Schwanke, Smith, and Edyburn's (Schwanke, T. D., 2001) A3 model describes how advocates have reacted to structural barriers by providing accommodations and, ultimately, accessibility. This paper synthesizes and evaluates three studies that attempted to improve accessibility in assessments for students who struggle with print reading through audio presentation of assessment items. Cross-study implications for policy and practice are considered.