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Many research reports and education policies have promoted Universal Design for Learning as an instructional framework that guides the design of inclusive learning experiences for students with diverse learning needs. However, there have been historical and ongoing debates on how to operationalize, implement, and measure the effectiveness of UDL, warranting further evaluation of research evidence and theoretical underpinnings of UDL implementation. In this study, we synthesized 31 peer-reviewed empirical studies that focused on UDL implementation in preK-12 settings. Results indicated significant differences in how researchers implemented UDL checkpoints, guidelines, and principles across studies. Moreover, few studies explicitly applied theories to inform interventions or instruction. Based on the findings, we discuss challenges with UDL implementation and provide recommendations for future research.