Research regarding the role of reading fluency for middle school-aged students with disabilities is limited, particularly for students with attention deficit hyperactivity disorder (ADHD). This study compares the roles--repeated silent reading (RSR), oral reading (OR), and repeated oral reading (ROR)--on grade-level comprehension for students identified with ADHD. An adaptive alternating treatment design with an extended baseline was used to compare the impact of each type of reading modification on comprehension. Researchers found OR and ROR of passages from a curriculum associated with acceptable performance on comprehension questions for those passages. Although students preferred silent reading, oral reading conditions were more consistently effective. Researchers discuss implications for the role of fluency in ADHD and general education classroom modifications.