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Dual language bilingual education (DLBE) continues to expand globally, but questions persist about content teachers’ attention to students’ language and literacy development in these contexts. This case study employs interviews, classroom observation, survey, and analysis of instructional materials to explore teachers’ perceptions and practices regarding the balance of content and language, and the incorporation of literacy instruction in DLBE. The study reveals content area teachers in DLBE settings perceive the importance of attending to students’ linguistic needs and literacy development, but that teachers struggle to implement classroom practice that meets these objectives. These findings shed light on the importance of addressing DLBE teacher preparation and professional development, to equip teachers to attend to the competing pedagogical demands of DLBE instruction.