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Mental reversibility is an individual’s ability to understand cause and effect relationships. Eleven low-achieving students were selected to be part of an intervention using tasks to promote reversibility, with 24 students in a control group. Using Convergent Parallel mixed methods, the purpose of this study was to investigate relationships between reversibility and mathematics achievement. Results indicate that although there were no significant changes in achievement gaps, there were significant increases in achievement early on in the study. Results also indicate three themes explained students’ engagement with reversibility tasks: counting thinking structures, composite unit thinking structures, and visual supports. Mixed results show that reversibility development and mathematics achievement increased when students’ coordinated counting and composite unit thinking structures via finger patterns.