A 7-year-old girl has difficulty reading despite normal intelligence, adequate educational exposure, and no sensory deficits. She makes letter reversals (b/d), struggles with phonological decoding, and reads slowly. What is the most likely diagnosis and the core deficit?

• A Intellectual Disability; global cognitive impairment
• B ADHD inattentive type; sustained attention deficit
• C Visual processing disorder; visuospatial deficit
• D Specific Learning Disorder with impairment in reading (Dyslexia); phonological processing deficit ✓

Explanation

Dyslexia (Specific Learning Disorder with impairment in reading in DSM-5) is primarily a phonological processing disorder — difficulty mapping graphemes to phonemes (sounds). This leads to poor decoding, slow reading, and spelling difficulties. Intelligence is normal. Visual processing problems (letter reversals) are a secondary consequence, not the core deficit. IQ-discrepancy criteria have been abandoned in DSM-5 in favor of evidence-based assessment. Early intervention with phonics-based (systematic phonological) instruction is most effective. ADHD can co-occur but sustained attention deficit alone does not explain phonological decoding failure.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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