The increasing “incidence” of learning disabilities and attention problems has been cited in numerous media outlets as well as in professional journals. As a physician working in this field, I am frequently asked: do I think the reported increase in cases of Dyslexia and ADHD is a true reflection of the situation? If so, to what do I attribute the increase?

Yes. I do think that there s been a rising incidence of both learning and attention difficulties. The answers to the questions of etiology are yet to be determined, though genetics and brain neurophysiology will certainly weigh heavily into the final equation.

However I also think that part of the increasing numbers is due to inaccurate labeling. Our “quick-fix” society encourages parents, teachers, and society to view Johnny s lack of conformity to his peers in a second grade classroom not as individualism to be celebrated – but rather as a problem worthy of medication.

Proper workups to diagnose a learning disability are sometimes bypassed due to the challenge they present to our complicated or inadequate healthcare system. Additionally there are other reasons – rooted in subcultures within this melting pot we call America – that we, as professionals, seldom pause to consider.

Take my own story, for instance. It s a classic case of how heritage and environment – the past – can influence the future.

I grew up in Appalachia, in the state of Virginia. Appalachia is a geographic region that includes different mountain ranges extending from Maine to Georgia. Its original settlers came from various parts of Europe (Ireland, Scotland, Wales, etc.) fleeing famine and poverty for the hope of a better life in America. They came as far west as these mountains.

They lived in isolation in the hills hoping to keep their native cultures intact. They did subsistence farming. As their poverty deepened over the years, many became miners employed by “big business” who had set up shop to take advantage of the rich coal resources in the area. These mountain folks were hard working, honest, and smart but “schooling” and “book learning” were not available to most. For those who could, work to help the family survive took precedence.

People in the mountains often bartered for needed goods with each other and outsiders without a cash currency. When later they received pay for hire, cash not checks was used for their meager salaries. Hence illiteracy was normative.

In the 1940 s and 50 s a great migration began from the mountain regions of Kentucky, Virginia, West Virginia, and Tennessee to big cities in Ohio and Michigan. Stripped of its minerals by mining operations, much of the land had become untenable for farming or continued mining. In order to feed their families, they went north to work in factories where literacy was not a requirement. My family was a part of this migration from the Blue Ridge Mountains of southwest Virginia to the big city of Dayton, Ohio.

In the city, children were required to attend school. I did not have parents who could help me with reading or math homework. It was not a priority for me or them amid the daily demands of a cultural transition or survival in the big city. My family moved frequently from job to job and as a result I changed schools frequently as well. In reflecting, I believe that just as my teachers would begin to figure out that I was unable to read, my family would move and I would be on to my next school. This pattern continued until the fifth grade.

It was there that I met Esther Stahl, an older, seasoned teacher beloved by the children at my new inner city elementary school. More than good fortune brought us together. It was a pivotal point in my life journey, a miracle, and the “favor of God” as I would later come to understand.

Within a few weeks Esther understood two important things about me. The first was that I couldn’t read. The second was that, in spite of that, I was smart. It meant everything to me that she understood not just the first reality but both.

With great diplomacy she asked if I would be willing to stay after school each day to help her clean the blackboard, straighten up the desks and the like. Amid being culturally different, I was thrilled to be singled out in such a positive way. A friendship began between a young struggling student and a wise, experienced teacher. Eventually she asked if I would be willing to help her choose new reading books for the first grade teacher. It never occurred to me that the first grade teacher was more than capable of accomplishing this task on her own.

And so began the process of my learning to read at eleven years of age. With first grade reading milestones accomplished, we made our way on to second grade books, and then third, and fourth, and eventually fifth. By the end of that fifth grade year I was reading, and reading at grade level!

The immediate difference in my life was staggering! The world opened up to me page by page taking me to places I could not have gone otherwise. The world was much bigger than my small dot on the map with all its struggles! My self esteem soared! I could do what other children seemed to do so naturally. I could read! I now knew that I was just as smart and just as capable. I could dream big dreams with a very real hope of achieving them. Being able to read and comprehend words on a page gave me the ability to dream!

It has been many years since that pivotal, life changing year with Miss Stahl. I continued to work hard and to dream big dreams. I did well in school and graduated as valedictorian of a large inner city high school. I received a full academic scholarship to a well respected private college. I went to medical school and achieved my “pie in the sky” dream of becoming a physician. I have been a professor of medicine. I also teach at a seminary. Books of all kinds have been a part of my life. I cannot imagine life without the ability to read and without books. Education broke the cycle of poverty for me.

Gratefully, some things have not changed. I have great respect for my heritage and all that it s taught me. My simple beginnings have been a valuable foundation for all the rest that followed. I still believe that wisdom and education are not synonymous. And I appreciate the wisdom passed on to me by the generations before me. Inner strength which was forged from the struggle of those early years remains with me even now. My “down home style” has positively distinguished me in my professional world.

I have often pondered how I might be labeled if I were an illiterate fifth grader today in a classroom with a busy, less experienced, and perhaps less compassionate teacher than Miss Stahl. Would my boredom in a reading circle where I had no interest in demonstrating what I could not do, be labeled as the daydreaming classic of ADD? Would my reluctance be seen as Oppositional Defiant Disorder? Would my inability to read and verbal stammering to attempt words unfamiliar to me be misperceived as dyslexia or another learning disorder, or borderline intellect? Who might have paid for an evaluation, or tutoring, or perhaps speech therapy or been able to take me to those appointments? Fortunately these considerations can stay within the scope of speculation

Illiteracy is not the most common cause of learning or attention symptoms. However it must not be forgotten! Within our rich cultural diversity in the United States, it is more common than any of us might think. Discovering the problem, and teaching a child or adult to read can literally make all the difference in the world!