Your preceptor has seen Katie since she was born (after an uncomplicated term pregnancy and spontaneous vaginal delivery). Katie’s only health problems have been mild asthma, for which she uses an inhaler, and seasonal allergies. There were no developmental concerns in the preschool period.

Mrs. O’Neil explains Katie has been refusing to practice reading and shows little patience for her spelling homework, although she doesn’t mind doing her math worksheets. The fall report card indicates Katie is frequently found staring out the window, but will respond when redirected to her school work. She draws well and prints neatly but never writes much on her journal assignments. She is not meeting classroom expectations for reading, spelling or written composition, has average grades in math, and excels in music and gym. She has been increasingly quiet in reading group and may complain of needing to use the washroom or having a stomachache when it is her turn to read aloud. Katie is well-behaved in class, has many friends, and until recently said she enjoyed attending school.

Your top differential diagnosis of Katie’s school problems includes: