In this synthesis, we analyzed 10 prealgebraic reasoning interventions for students with mathematics difficulty (MD) in Grades 6 through 8. All interventions focused on one or more prealgebraic concepts including integer operations, algebraic expressions and equations, and functions. Of the 10 intervention studies, six employed single-case design methodology and four employed group design. We synthesized intervention effects and identified instructional practices utilized within interventions. Results indicated positive proximal student performance across studies, generally positive maintenance effects, and mixed transfer effects. Manipulative-based instruction and explicit instruction were the two most used instructional practices within interventions, supporting their use in improving targeted prealgebraic reasoning skills among students with MD. Additional implications for research and practice are discussed.