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- By Elyse Wild
When Joshuaa Allison-Burbank (Diné, Acoma Pueblo) worked as a speech pathologist in his home community of the Navajo Nation, he saw an effect of colonialism, boarding schools and broken treaty promises that is rarely discussed: significant speech delays in Native children.
As the only speech pathologist in the IHS service area of Shiprock, New Mexico, Allison-Burbank began asking: “Why are so many Native children not talking at these time points when we expect them to be talking?”
Now, Allison-Burbank is leading a study with the Johns Hopkins Center for Indigenous Health that aims to bring Native children the support they need to overcome speech delays — all within the context of their Native languages.
Dubbed +Language is Medicine, the four-year study is funded by a $3.1 million grant from the National Institutes of Health and will utilize the unique challenges faced by extremely rural Native communities to bring interventions centered in their cultures.
Allison-Burbank talked to Native News Online about the act of connection that lies at the core of many Native languages; the snowball effect of unaddressed developmental delays; and leveraging tribal home visiting programs to expand access to treatment.
Where did you grow up and what did you love about your community?
My mom is Diné and my dad is from Acoma Pueblo. I was born and raised on the Navajo Nation, and I've been very fortunate to learn from and know both sides of my tribal connections. One of the best things about growing up on the reservation in I grew up in Tohatchi, New Mexico. I was just always being around cousins and family. There were always people around, and that's what I miss. I go home a lot, but I'm not there all the time. That was one of my favorite things about my upbringing—just being around family and being around cousins.
What drew you to work in speech-language pathology?
I was really drawn to the field of speech-language pathology early on, like in high school. I was drawn to the field and drawn to the anatomy of communication as a high school student. Then I made the connection back then that there were Native people with disabilities, and that's when I really got interested in the field. That's really where my journey started.
I became a licensed speech pathologist. I still practice, mostly in early intervention. I work with both tribes—the Navajo Nation and the Acoma—supporting children. I'm now focused on seeing babies three and under. I still try to maintain that clinical perspective. I see kids in small amounts even as a full-time researcher, so it informs the work and helps me come up with these ideas.
After I finished school, I joined the Indian Health Service, and that's what brought me back from the University of Kansas to the Indian Health Service in Shiprock [Ariz.] The majority of kids I was seeing back then, in 2020 and 2022—kids mostly under age five—the majority had preventable developmental delay. So they were either late talkers or had experienced some type of neglect or trauma that impacted their developmental trajectory. I was working in a clinic, scheduling appointments, seeing one patient for an hour, then doing it all over again. But I was working in a very high-needs area in New Mexico, and I was the only speech therapist with a pretty wide service area, including Arizona and Utah.
What led you to the Center for Indigenous Health?
Dealing with speech pathology and public health, my research brain turned on, and I was asking: Why are there so many Native children with developmental delay? Why are so many Native children not talking at these time points when we expect them to be talking? That's when I got motivated to get back into academia and do research.
I was invited to take a job with Johns Hopkins Center for Indigenous Health as an assistant scientist, which would allow me to stay here in the community, work as a clinician, and also build my research portfolio. I have a full-time job now with Johns Hopkins with full-time faculty privileges, but I do research and write grants to further explore that big research question: Why do children talk late on the reservation? Why is developmental delay so significant in these tribal communities?
It's not just here in this location—I've worked in different tribal communities, and there are similar trends, similar high rates of developmental delay. That's what I've been trying to figure out through this support from the Center for Indigenous Health: How do I address that and answer that question?
What are the developmental milestones that tell you a child has a delay?
Developmental delay refers to a young child's delay in one of their developmental areas. It's broken down by communication, motor skills, problem-solving (which is early cognition), and social-emotional development. We think about a child's development across all those areas. When there's a delay in two or more areas, we call it a developmental delay.
You can have a speech and language delay where the kid's just not talking, but everything else—they're walking, they're crawling, they can problem solve—it's just the language that's not coming out. You can have motor delays as well, where kids aren't walking but they're talking. When we define developmental delay as two or more areas, that means we're not just going to focus on one area—we're going to focus on the whole child across all developmental domains.
You can see delays as early as five to ten months if they're not rolling over, if they're not laughing, if they're not making eye contact. A lot of those screenings done early on in infancy are meant to catch those developmental delays early. We have good tools out there. We know that children talk at 12 months—they say their first words. That's across any language. Even children who are deaf will sign or gesture around that month, around the 12-month period to communicate. So it's universal.
When we don't hit those milestones, especially that important one, that's when we have to really ask: What's contributing to that delay and why? What can we do about it? The significance of developmental delay is that it can be identified early on, and depending on what it is—if it's a neurodevelopmental disability like autism or fragile X or fetal alcohol syndrome—we know how to treat those. There are interventions out there. That's why we're really trying to identify these cases early on, so we can intervene early, so we can try to remediate or reduce the level of support needs that are needed across childhood.
It's important to intervene early because we can save a lot of time and money and heartache if we're not waiting until this really advances and there's a big need when kids are starting school or when they get to adulthood. If these developmental disabilities aren't addressed and supported, these kids grow up to be adults and they continue to have difficulties. It impacts their relationships, their parenting, their quality of life. That's really what I'm trying to do from this public health lens—address this early on. If it's preventable, do as much as we can to prevent it from progressing or to remediate it completely.
So we know what developmental delays are, why support is crucial, and that Native kids experience a disspraporationate amount of them. Tell me about the Language is Medicine program.
Language is Medicine is the name of the study and also the name of the intervention approach. We use evidence-based strategies—what a speech therapist would do with an infant or toddler in a traditional clinical setting. What we're doing with the Language is Medicine approach is teaching tribal home visitors who are already working in the community, who speak the language, who are experiencing life with those families already as part of their community, and we teach them the skills that I learned as a speech therapist, and they go out and do it.
Not only are they teaching these speech therapy strategies, but they're also addressing things across those developmental areas like book reading, early literacy, and pretend play. One of our final lessons focuses on increasing native-language use. This intervention is meant to address the whole Native child—to support their developmental delays and teach them things that will build and improve other areas of their development. So their gross and fine motor skills, their problem solving, their early literacy and early academic experiences, but most importantly, their native language use.
We help families see that they can do all this work within their cultural context—like ceremonies and powwows, coming-of-age events their families are part of, feeding the sheep, collecting wood, farming, or planting. We teach those families that you can use these strategies within those contexts. And here's what it could look like. Here's how I do it as a speech therapist.
We use a coaching model called Teach-Model-Coach. We teach them, we model it to them, and then we coach them through that learning experience. We further tailor it—since this is focused on Navajo families, we indigenized that whole concept by turning it from Teach-Model-Coach to Teach-Model-K'é. K'é in Navajo means kinship ties, family balance, relationships. That's how we frame it: We want to honor your child. We want to honor your home and your routines. Here's how you can improve or increase the quality of those interactions to support your child's development. And here's what it looks like through some videos and coaching and intervention.
It's meant to be short and sweet. Our goal is not to take over those families' lives. Our goal is to fill up their toolbox of parenting strategies so they can take it from there and support their child and remediate the delays.
What did your pilot study show?
Our pilot study was done in the northern agency of the Navajo Nation, and it worked. We were able to coach home visitors from the community to do what I did, culturally tailor it, and then we did some pre- and post-intervention checks, and these kids' language development improved.
We put that pilot data into this larger NIH grant proposal, and that's what got funded. We have $3 million now to do a randomized control trial over four years, and we're able to compare our intervention and our approach to a control intervention, really examining those effects. We're working on the eastern part of the Navajo Nation, a very underserved area, very rural area. We're talking about communities that don't even have a gas station. That's where we're trying to reach—those underserved communities.
Can you talk about what we know about raising kids with their Native language and how that improves their well-being?
That's a really special topic to elaborate on. I think it comes down to connection. Language allows for connection. It allows for attachment to your child. It allows for identity. That's one of the first things we do as Native people—we introduce ourselves. The Navajos always have their long list: from this clan, my mom, my parents, my grandparents. It's kind of funny to see off the reservation when you get another Navajo introducing themselves—it's long, and they end it with, "Here's where I'm from, my hometown, my community."
That's how I identify as a Navajo-Pueblo man. After I say my name, where I'm from, my clans, what I do, then we end with that. That's how we introduce ourselves. That's how I identify. Those teachings, those practices—they allow for those important connections. If you have a relative right in front of you, you shift how you talk, how you exchange. If there's another elder in front of you, you're going to obviously shift that communication. Another Indigenous person as well, and then a non-Native person—you're always going to be establishing those connections because those relationships are different. They're all important to maintain and connect.
I really think of it from that perspective. We're always trying to connect. Even if you're out there as a Diné person in the middle of nowhere with just the elements, no humans around, you still greet the land—yá'át'ééh—you still do that, you still say that, you identify, you introduce yourself.
That's the foundation, my theoretical framework: How do I help children who are experiencing developmental delays? How can I help them to have that chance to do that as well? I think that's really why we see strong language in communities here in the Southwest that prioritize the connection. We look at how we help people have a better relationship with their parents and their community. That's where it starts.
It's very different from the Western model that says if someone is disordered or delayed, we need to fix them so they have a better chance of doing well in the community independently. But that's not the Native way. We're looking at restoring connections with one another and the land and space as well. That's really the main influence on the work that I do: How do we restore connection?
I look at our intervention, which is a language intervention. How does language improve developmental trajectory? Well, if we can get parents to talk more with their kids, we're providing a model, getting them excited. They're spending more time with their child. Maybe that child becomes less anxious, more attached to their parents, sees that their parents are tuned in with them, and wants to spend time with them. They actually have a strong relationship.
Language is powerful because you need to have connections with your parent or caregiver to learn, experience, and make sense of things. You feel protected. You're able to be educated on certain things.
Can you give an example?
Think about fire. The parent is the one who tells the kid, "Don't touch that, it's hot." We had relatives visiting overnight recently, a young child, and we have a wood-burning stove. That young child just sees the fire, sees the lights, and they want to go to it. They're attracted to it. But the parents come in and say, "Don't touch that. It's hot." And they protect them as well. They say, "Don't touch that. It's hot. Look, feel it. Don't go up there."
That type of language and direction—they're not teaching the child by putting their hand into the fire. You're talking to them, you're explaining it to them, you're gesturing and showing it to them. That's just one example of how a child learns that fire is hot. There are all these different things throughout life that that kid has to learn through that early childhood experience.
That's how we focus on this work—showing that you're teaching, you're talking, you're explaining, but that child is going to trust that parent more. They want to learn because that connection is there. The parent talked to them, the parent went over and grabbed the child and was holding them. That's one example we give often: How does the child—how does the caregiver—not just protect the child, but in doing so, how do they teach them and let them learn? It all comes down to the language, and it can be in English or Diné or any other Indigenous language.
But that's what's been so impacted by colonialism—the stress, the trauma, the need to work, the need to hustle every day. There's just no time for that type of interaction to happen. I think that's a main cause of the delays in Native communities—that time just isn't there. There's not enough time to use language to teach important things to that young child. That's really what we're trying to do—restore these connections through these whole community and cultural routines.
What are your hopes for this study? What are you most looking forward to?
My hope is that the intervention is proven to work across a larger sample size. One focus of this grant is mapping out what it would take for this intervention to be sustainable, to take it to scale, to make it permanent within the Navajo Nation, but also how it can be replicated elsewhere.
Our approach is a pretty standardized approach to coaching people. What we added was the cultural language tailoring after we came up with the approach. That means we can take that approach and apply it elsewhere. If this works and we can address early developmental delays within our sample size, we can take it to the whole Navajo Nation. Here's our solution to addressing this high rate of developmental delay. Here's how we improve school readiness. Here's how we address early indicators of learning disabilities. Here's how we can support these kids better.
We can also take it to other communities as well. We have Language is Medicine in the English version, we have the Navajo version, but we can easily have Language is Medicine in Ojibwe, Cree — any language. This approach can be applied—that's how it's been designed from the start. We wanted it to be replicable across any community. It doesn't have to be Indigenous, but we added that cultural and language tailoring, and we're tracking how that works.
That's the next goal: Can we take this to scale? Can we replicate this elsewhere in another Indigenous language? We already have interest in other communities across the U.S. that want to do this as well, to use their home visiting programs. Tribal home visiting programs are already well-funded. You just have to have the infrastructure and the tribes willing to try it and do it. It's funded by the U.S. Health and Human Services, and there are dozens, if not hundreds, of programs already across the United States.
This program is meant to work within that home visiting program to address those higher rates of developmental delays. It's not meant to replace special education. It's meant to be a safety net program to help support kids who are experiencing delays better in hard-to-reach areas, like where I worked in New Mexico. That's really the big goal—take it to scale and replicate across other Native communities.
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