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Nearly every mathematics teacher teaches linguistically marginalized students, yet rarely receive preparation or professional development (PD) on teaching mathematics to multilingual learners (MLs). As part of a larger, three-year design-based study, we investigate how mathematics teachers make sense of teaching MLs using constant comparative analysis. We found that teachers experienced tensions and challenges related to teaching MLs, sometimes drawing on binary frames. Additionally, we found that teachers 1) grapple with choosing between teaching math or language; 2) navigate tensions between dominant language ideologies and teaching MLs; 3) view challenges as either systemic or individual shortcomings; and 4) feel responsible for MLs’ social and emotional well-being. These findings extend the field’s understanding of how mathematics teachers make sense of teaching MLs.