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This study examined mainstream elementary school teachers’ self-assessments of pedagogical content knowledge (PCK) in literacy and language instruction for multilingual learners (MLs) in a high-needs school district. Additionally, MLs’ perceptions of challenges to literacy and language development were also investigated. Grounded theory coding was used as the analytic method to categorize responses and compare themes within and across teacher and student groups. The findings demonstrate that mainstream elementary teachers of MLs state a need for more explicit education in integrating language, foundational literacy, and content-area instruction, while MLs indicate a need for more explicit instruction in foundational literacy, language, and communication skills. Implications for professional development are discussed.