More than two-thirds of middle school students do not read proficiently. Research has shown that targeted interventions using explicit instruction methods can improve reading outcomes for struggling readers. A central feature of explicit instruction is the systematic implementation of instructional interactions, but it is not clear what specific instructional interaction practices lead to stronger outcomes for middle school readers. This study used a regression discontinuity design to compare the frequency and impact of instructional interactions experienced by U.S. eighth-grade students who received a targeted reading intervention (n = 1,461) with those who did not (n = 4,292). Results indicated that students who received intervention experienced far more instructional interactions with their teachers than did students who did not. However, the association between rates of interaction and student need in the intervention group was minimal, and the relationship between the rate of instructional interactions and reading growth was mixed. Implications for intervening with struggling students in the middle grades are discussed.