This study determines the relative difficulty and associated strategy use of arithmetic (addition and subtraction) story problems when presented in American Sign Language to primary level (K-3) deaf and hard-of-hearing students. Results showed that deaf and hard-of-hearing students may consider and respond to arithmetic story problems differently than their hearing peers, with the critical dimension in problem difficulty being based on the operation typically used to solve the problem, not the story within the problem. The types of strategies used by the students supported the order of problem difficulty. The visual-spatial nature of the problem presentation appeared not to assist the deaf and hard-of-hearing students in solving the problems. Factors that may have contributed to this pattern of problem difficulty are discussed so that educators can better align mathematics instruction to the thinking of the deaf child.