Research has shown phonological awareness training is effective in improving phonological awareness and reading ability in typical children and in children with language impairments (Gillam, Crofford, Gale & Hoffman, 2001; Gillon, 2000). Very few investigations have examined the process of phonological awareness and literacy learning in children with moderate/severe language impairment who demonstrate average to below average cognitive ability. The purpose of this study was; 1) To investigate the effects of a phonological awareness program on the phonological awareness and single word reading ability of children with moderate-severe language impairment, 2) To assess reading change in word recognition (decoding and sight word knowledge) for children with moderate-severe language impairment, and, 3) To determine whether one treatment approach (phonological awareness intervention [PAI]) or reading intervention (RI) impacted more than the other on overall performance in both domains. Findings revealed that either treatment was effective in improving phonological awareness and word recognition regardless of the focus of the intervention program.