In this era of education accountability, teachers are looking closely at grade level requirements and assessment of student performance. Grade retention is being considered for both students with and without disabilities if they are not meeting end of the year achievement benchmarks. Although research has shown that retention is not the best alternative for struggling students, many teachers recommend retention because there are not any other viable alternatives (Lincove & Painter, 2006). The purpose of this study was to investigate teacher attitudes toward grade retention and if teacher practices differ when recommending retention of students with or without disabilities. The research questions that guided this study were: (1) Are there differences in elementary teacher decision making process regarding retention for students with and without disabilities?; (2) What factors influence elementary teachers' decision making process about retaining students with or without disabilities?; and (3) How does student performance on state testing affect elementary teachers' decision making process about retaining students with or without disabilities? This mixed methods study utilized a paper and pencil questionnaire using a Likert scale, as well as two open ended questions and a checklist. A total of N = 9 teacher interviews were also conducted. The quantitative data compiled from the questionnaire for N = 74 teachers were analyzed by using a paired t-test and descriptive statistics. The qualitative data were gathered from the interview responses and open ended questions to compile themes. The findings of this study indicate that teachers are considering a multitude of factors when considering grade retention for their struggling students. Academic performance was the factor that teachers (77%) indicated the most frequently when considering retention for both students with and without disabilities. Although teachers felt pressure and accountability from high stakes testing, they felt test results should be one of many factors considered in the retention decision. After a review of the findings in this study it is recommended that district administrators continue to consider various interventions for struggling students and provide professional development for teachers on how to implement them. Future research is recommended in the area of interventions for struggling students and supporting students with disabilities on high stakes testing. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml