This study directly compared four patients who, to varying degrees, showed the characteristics of deep dyslexia, dysphasia and/or dysgraphia-i.e., they made semantic errors in oral reading, repetition and/or spelling to dictation. The "primary systems" hypothesis proposes that these different conditions result from severe impairment to a common phonological system, rather than damage to task-specific mechanisms (i.e. grapheme-phoneme conversion). By this view, deep dyslexic/dysphasic patients should show overlapping deficits but previous studies have not directly compared them. All four patients in the current study showed poor phonological production across different tasks, including repetition, reading aloud and spoken picture naming, in line with the primary systems hypothesis. They also showed severe deficits in tasks that required the manipulation of phonology, such as phoneme addition and deletion. Some of the characteristics of the deep syndromes - namely lexicality and imageability effects - were typically observed in all of the tasks, regardless of whether semantic errors occurred or not, suggesting that the patients' phonological deficits impacted on repetition, reading aloud and spelling to dictation in similar ways. Differences between the syndromes were accounted for by variation in other primary systems-particularly auditory processing. Deep dysphasic symptoms occurred when the impact of phonological input on spoken output was disrupted or reduced, either as a result of auditory/phonological impairment, or for patients with good phonological input analysis, when repetition was delayed. 'Deep' disorders of reading aloud, repetition and spelling can therefore be explained in terms of damage to interacting primary systems such as phonology, semantics and vision, with phonology playing a critical role. © 2006 Elsevier Ltd. All rights reserved.