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					CHILD BEHAVIOUR
Introduction
           Psychology (Morgan)


              Human nature




Function                         Behavior
                 Child psychology
It is the science that deals with the developing mental
power or an interaction between the conscious and

subconscious element in a child. (Morgan)



                      Behaviour
It is any change observed in the functioning of the

organism. (Morgan)
                       Emotion
An effective state of consciousness in which joy, sorrow,

fear, hate or likes are expressed (Morgan)
        Importance of child psychology



Understand                Comfortable environment

Communicate               Better treatment planning

Gain confidence           Practical suggestions

Positive attitude         Effective dental services



How we can achieve it ?
                     Objectives

By knowing and understanding several dimensions of
child's psychological development .



By knowing what emotional and social behavior to
expect from children in different age groups.
Theories of child psychology
                      Thompson

Psychoanalytic theory - Freud

Psychoanalytic–behavioristic theory – Dollard & Miller

Theory involving critical period – Erickson

Cognitive field theory – Piaget

Neo-behavioristic theory – Hull

Others – Skinner, Murray
                       Morgan

I. Dynamic personality theories

      Psychoanalytic theory - Freud

      Analytical psychology - Jung

      Individual psychology – Adler

      Psychoanalytic – interpersonal theory- Horney
II. Learning and behavioral theory

          Early social learning theory – Dollard & Miller

          Radical behaviorism – Skinner

          Late social theory – Bandura & Walters



III. Humanistic theories

          Self theory – Rogers

          Self actualization theory – Maslow
                    Tandon 2001

Child psychology theories can be broadly classified into
two groups.



      I. Psychodynamic theories

              Psychosexual theory - Freud
              Psychosocial theory - Eric Erickson

              Cognitive theory - Piaget
II. Behavioural theories



       Hierarchy of needs       -   Maslow

       Social learning theory   -   Bandura

       Classical conditioning   -   Pavlov

       Operant conditioning     -   Skinner
               Importance of theories


They are useful in integrating and abstracting normal
and abnormality of natural phenomena.



They often suggest the next steps in development.



They act as guide for the scientist in further research.
Method of construction of theories


           t   Theory, most inclusive
                Theories, level II
                  Miniature theories, level lII
                     Empirical relationships

                       Observation\instrumentation

                          Direct observation
              Charles Darwin (1877)




Baby Biography

William (Doddy) - Use to throw objects at 2 year.

But this tendency is not seen in his infant daughter.

Throwing objects inherited tendency of boys.
Psychodynamic theories
   Psychoanalytical / Psychosexual theory
Sigmond Freud (1905)




Personality develops from biological roots, as a result of
satisfaction to a set of instincts of which sexual instinct
was the most important.
Psychoanalytic theory has three major parts

      Theory of structure and personality

      Theory of personality dynamics

      Theory of Psycho sexual development



At each stage sexual energy is invested in a particular
part called an erogenous zone.
     Theory of structure and personality

                             Id
• It is the basic structure of personality

• It serves as a reservoir of instincts

• It present at birth

• Impulse ridden and strives for immediate pleasure
  and gratification

• Works on pleasure principle.
•   Eg- Urge to drink, eat, eliminate.



•   The energy underlying these urge he call as sexual
    energy ie libido.



•   Child wants to satisfy its fundamental urges
    immediately and reflexively as they arose.with out
    caring for rules, reality or moral of life.
                            Ego

•   It develops out of Id in the 2nd to 6th month of life
    when the infant begins to distinguish between itself
    and the outside world



•   It is the mediation between Id and super Ego.



•   It is governed by the reality principle.
•   It is concerned with memory and judgment.



•   It is developed after birth, expands with age.



•   It delays, modifies and control Id impulses on a
    realistic level (reality principle) that is more socially
    acceptable out lets.
                        Super Ego
•   It is the prohibition learned from environment (parents
    and authorities).

•   It acts as a censor of thoughts, feelings and behavior.

•   It is determined by regulations imposed upon the
    child by parents society, and culture (ethics and
    morals).

•   It is the internalized control which produces the
    feeling of shame and guilt.
       Theory of personality dynamics

                               Conscious
Superego                       Preconscious

Ego                                Instant memory


                               Unconscious

 Id                              Hidden memory


                                   Pen slip
                                   Tongue slip
         Freud’s stages of development

Birth

•   It is the first experience to effect personality
    development.

•   Abrupt change at birth result in psycho-physiological
    emergency reactions

•   These reactions help the child to learn some
    adaptive mechanisms against anxiety generating
    stimuli.
•   The characteristics are observed in later life during
    personality development and depend on child’s
    susceptibility during this period.



•   If the neonate gets used to the stimuli he is no
    longer anxious.



•   Neonates who fail to adapt to abrupt changes get
    anxious easily.
                    Oral Stage 0-1

•   In infants the oral cavity is the site for identifying
    needs.



•   It therefore serves as an erogenous zone.



•   This is a dependent stage since the infant is
    dependent on adults for getting his oral needs fulfilled.
•   Satisfaction of oral desires help in development of
    trust e.g., suckling of milk by mother later by teething
    or biting

•   In later period of life early developed trust results in
    successful achievement of needs



•   If child’s needs are not adequately met in this stage
    baby develops oral fixation which in adult hood
    results in development of oral habits or biting
    personality.
                      Anal stage 2-3

•   During this stage, maturation of neuromuscular
    control occurs.



•   Control over sphincters particularly anal sphincter
    results in increased voluntary activity.



•   Development        of   personal     autonomy     and
    independence.
•   First part of anal stage involves pleaser from
    expulsion of feces.

•   Latter part involves pleaser from retention



•   Fixation in first sub stage results in adult character of
    messiness and disorder.

•   Fixation in latter sub stage results in adult character
    of excessive compulsiveness overconfermity,
    exaggerated self control.
•   Child realizes his control over his needs and
    practices it with a sense of shame or self-doubt.



•   The child realizes the increasing voluntary control
    which provides him with the sense of independence
    and autonomy.
                 Urethral stage 2-3


•   The child derives pleasures from exercising control
    over the urinary sphincter.

•   voluntary control will provides him with the sense of
    independence and autonomy.

•   Loss of urethra control results in shame.
                   Phallic stage 4-5

•   The stage begins during the 4th year of life till the 5th
    year.



•   It is characterized by

       Oedipus complex

       Electra complex
•   There is an increase unusual fantasies about
    opposite sex

•   The child realizes the sexual qualities without
    embarrassment.



•   If the above mentioned characteristics are not
    resolved the balance between male and female
    roles does not develop.
                     Oedipus complex

•   The name of the oedipal complex comes from Greek
    mythology.



•   Oedipus the King of Thebe, unknowingly killed his
    father and married his mother.



•   Young boys have a natural tendency to be attached
    to the mother.
•   They consider their father as their enemy.



•   They strive to imitate their father to gain the affection
    of the mother.



•   The little boy adopts his father’s manners, his
    attitudes and interests thinking that by becoming like
    his father he can win his mother’s love.
                   Electra complex

•   In Greek mythology, electra helped her brother to kill
    the lover of their father Agemennou, in order to win
    her father’s love.

•   The young girls develop an attraction towards their
    father

•   Freud    has   reported   that   little   girls   have   a
    comparable electra complex to resolve this.
                 Latency stage 6-12


•   Resolution of any defects occurs in this phase.

•   The phase ends in puberty.

•   Maturation of ego takes place.

•   There develops a greater degree of control over
    instinctual impulses.

•   Child gains better sense of initiative & starts
    adapting to the adverse environment
•   The goal of this phase is the further development of
    personality.

•   Consolidation of sex roles occurs.

•   These result in maturation of ego and mastery over
    skills.

•   Lack of inner control or excessive inner control result
    in a pathological trait.

•   Lack results in an immature behaviour & decreased
    development of skills.
                 Genital stage 13-18

•   Psychosexual development extends from 11 years
    to young adulthood.

•   Sense of identity develops.

•   Child has a matured personality.

•   He can satisfy genital potency & realizes his goals
    for reproduction and survival.
•   separate from the dependence on parents.



•   Their acceptance of adult role, functions with social
    expectations and cultural values.



•   Unresolved traits from previous phases are seen in a
    modified form.
                 Psychosocial theory

•   Erik Erikson.



•   Sigmund Freud’s theory is greatly extended by Erik
    Erikson.



•   Erikson worked on conscious and unconscious
    instincts.
•   Freud and Erikson share some assumptions.



•   Development depends upon child’s instincts and
    responses of those around him.



•   Unresolved issues from early stages of life affect
    person’s ability to deal with subsequent stages.
Erickson described 8 stages of life cycle which are
marked by internal crises defined as the turning
points/periods.
        Basic trust versus basic mistrust

(Birth to 18 months)

•   Meeting both the physiologic and emotional needs
    of the infant consistently by mother or mother-
    substitute results in successful development of trust

•   proper mothering develops a strong bond of love
    and trust between parent and child.

•   This bond allows the child to develop basic trust in
    the world
•   strong bond between the parent and the child at this
    stage is reflected in a strong sense of separation
    anxiety in the child when separated from the parent.



•   Therefore, it is necessary to allow the parent be
    present with the child of this stage when given
    dental treatment.
•   In cases of syndrome of maternal deprivation, an
    infant receiving inadequate maternal support fail to
    gain weight and are retarded in their physical and
    emotional growth and result in a lack of sense of
    basic trust.



•   Unstable mothering that occur with children from
    broken families or child in foster homes
•   child with sense of mistrust will have difficulty
    entering into situations that require trust and
    confidence in another person.



•   So such a child will be extremely frightened and
    uncooperative patient who needs special effort to
    establish rapport and trust with the dentist and staff.
      Autonomy versus shame and doubt


(18 months to 3 years)

•   Children around the age of 2 often are called terrible
    twos because of their uncooperative and frequently
    obnoxious behaviour.



•   At this stage, the child is moving away from the
    mother and developing a sense of individual identity
    or autonomy.
•   Failure to develop a proper sense of autonomy
    results in the development of doubts in the child’s
    mind about his ability to stand alone, and this in turn
    produces doubts about others.
•   A key toward obtaining cooperation with treatment
    from a child at this stage is to have the child think
    that whatever the dentist wants was his or her own
    choice, not something required by another person.
    Eg- either a green or yellow napkin for the neck.
•   Complex dental treatment of children at this age is
    very challenging and may require extra behaviour
    management procedure e.g., sedation or general
    anesthesia.



•   A child at this stage unwilling to separate from her
    so allow the parent to be present during treatment.
•   Lack of sense of self control (autonomy) in children
    results in shame and doubt.



•   A favorable ratio of autonomy to shame and doubt
    results in self direction with self esteem.
                  Initiative versus guilt

(3-6 years)

•   In this stage the child continues to develop greater
    autonomy, but now adds to it planning of various
    activities.



•   The initiative is shown by physical activity and
    motion, extreme curiosity and questioning and
    aggressive talking.
•   In this stage channel the child into manageable
    tasks,

•   preventing him/her from undertaking tasks where
    success is not possible.



•   At this stage a child is inherently teachable.



•   One part of initiative is the eager modeling of
    behaviour of those whom he/she respects.
•   In Erickson's view, the child’s ultimate ability to
    initiate new ideas or activities depends upon
    success in this stage



•   The opposite of initiative is guilt resulting from goals
    that are not attained
•   For most children, the first visit to the dentist comes
    during this period.



•   Going to the dentist can be constructed as a new
    and challenging adventure in which the child can
    experience success.



•   Success in coping with the anxiety of visiting the
    dentist can help develop greater independence and
    produce a sense of accomplishment.
•   A child at this stage will be intensely curious about
    the dentist’s office and eager to learn about things
    found there.



•   so an exploratory visit with the mother present and
    with little treatment accomplished usually in the first
    visit gives a good start.
•   After the initial experience a child at this stage can
    usually tolerate being separated from the mother for
    the treatment



•   Likely to behave better in this arrangement, so that
    independence       rather    than     dependence     is
    reinforced.



•   The optimum outcome i.e., a favorable ratio of
    initiative to guilt results in a sense of purpose.
            Industry versus inferiority

(7 to 11 years)

•   At this stage, the child is working to acquire the
    academic and social skills that will allow him/her
    compete in an environment



•   At the same time, the child is learning the rules by
    which the world is organized.
•   In    Erickson's   terms,     the    child   acquires
    industriousness and begins the preparation for
    entrance into a competitive world.



•   It   becomes   clear   that   some   tasks   can   be
    accomplished only by cooperating with others.



•   The role of parents decrease and influence of pear
    group increases.
•   The negative side of this stage is however a sense
    of inferiorly, inadequacy and uselessness.



•   So challenges that have a reasonable chance of
    being met rather than guarantee failure.
•   It is important for the dentist to listen to the child.



•   Try   to     explain   the   treatment    with   improved
    acceptance or status from the peer group

    i.e., how teeth will make his smile look better rather
    than trying to motivate him to achieve good
    occlusion which perhaps his peer group is not likely
    to notice.
•   A child at this stage should be actively made to
    participate in the treatment by emphasizing his
    responsibility to wear an appliance faithfully and
    maintain oral hygiene by regular brushing.



•   It should be kept in mind that the favorable ratio of
    industry to inferiorly leads to a sense of competence
    and pleasure in work so assign that task to the child
    which he is capable of.
          Identity versus role confusion


(12 to 17 years)

•   This is the stage in which a unique personal identity
    is acquired.

•   This sense of identity includes both a feeling of
    belonging to a larger group and a realization that
    one can exist outside the family.

•   It’s a very complex stage.
•   In this stage in order to establish one’s identity the
    person partially withdraws from the family and the
    peer group increases and so does the peer
    influence.



•   Members of the peer group become important role
    models and the values and tastes of parents are
    likely to be rejected.
•   At the same time, some separation from the peer
    group   is   necessary   to    establish   one’s   own
    uniqueness and value.



•   As adolescence progresses, an inability to separate
    from the group indicates some failure in identity
    development.

•   This in turn can lead to poor sense of direction for
    the future, confusions regarding one’s place in
    society and low self esteem.
•   The behaviour management of adolescent can be
    extremely challenging



•   Motivation for treatment may be internal or external.



•   External motivation is pressure from others whereas
    internal motivation is provided by an individual’s own
    desire for treatment
•   Peer group approval in extremely important.

    There was a time in U.S. where a certain stigma was
    attached to anyone wearing braces



•   Difficulty in getting Peer group approval leads to role
    confusion.

•   A favorable ratio of identity to role confusion leads to
    a sense of consistency.
             Intimacy versus isolation

(Young adult)

•   The adult stages of development begins with the
    attainment of intimate relationships with others.
    Successful development of intimacy depends on a
    willingness to compromise and even to sacrifice to
    maintain a relationship.

•   Success leads to establishment of affiliation and
    partnership whereas failure leads to isolation.
          Generativity versus stagnation

(Adult)



•   Generativity includes productivity and creativity, to
    preparing the next generation.



•   It is realizing your responsibility not only as a
    responsible parent, citizen, neighbor.
•   The opposite personality character in mature adults
    is stagnation, characterized by self indulgence and
    self centered behaviour.



•   Care is the outcome of a favorable generativity to
    stagnation ratio.
            Ego integrity versus despair

(Late adult)

•   The final stage is the attainment of integrity.



•   At this stage, the individual has adapted to the
    combination of gratification and disappointment.



•   A favourable ratio of ego integrity to despair beings
    wisdom and the ability to face death calmly.
                   Cognitive theory

Jean Piaget (Swiss psychologist )



•   Theory explains how children and adolescents think
    and acquire knowledge.

•   According to Piaget, the environment does not
    shape child behaviour but the child and adult
    actively seek to understand the environment and
    adapt to it.
•   Every individual is born with the capacity to adjust or
    adapt to both the physical and socio-cultural
    environments in which he or she must line.
In Piaget’s view the process of adaptation is made up of
3 functional variants

Assimilation, Accommodation, Equilibrium



Assimilation: It concerns with observing, recognizing,
taking up an object and relating it with earlier
experiences or categories.
Accommodation: It accounts for changing concepts
and strategies as a result new assimilated information.
Piaget calls the strategies and mental categories as
‘schemes’.



Equilibration: It refers to changing basic assumptions
following adjustments in assimilated knowledge so that
face fits better.
Eg – Adaptation of suckling

      Recognizing parents

      Permanency sachem

      Toy generalization
According to theory, life can be divided into 4 major
   stages



             * Sensorimotor stage (0 – 2 years)

             * Pre-operational stage (2 – 6 years)

             * Concrete operation stage (6 – 12 years)

             * Formal operation stage (11 – 15 years)
                 Sensory-motor period

•   During the first 2 years of life



•   Infant who is almost totally dependent on reflex
    activities



•   Infant try to know the world with sensory,
    perceptual,and motoric aspects.
• During this stage the child develops permanent
  concepts of objects.

• First 8 months unaware of object permanency
•10-12 month baby develops permanency of object
scheme
•   1st month Practice reflexes

•   2-12 month produce new effect and repeat
       *scratching sheet

•   12-18 month experiments

        *varying force scratching

•   18 month onward stage of plastic reflection

       Eg- piaget’s daughter lucienne with match box

•   Sensory motor thought mingled with internalized
    thoughts.
•   Language develop during this time



•   But at this stage communication between a child and
    an adult is extremely limited due to child’s simple
    concepts and lack of language capabilities.



•   At this stage, a child has little ability to interpret
    sensory data and a limited ability to project forward
    or backward in time.
                Preoperational period

•   During this stage the child uses symbols and
    language.

•   The child solves the problem by intuitive thinking but
    can not explain why.



•   Children in the pre-operational period try to
    understand the world in the way they sense it
    through the five primary senses.
•   Concepts that cannot be seen, heard, smelled,
    tasted or felt child can not believe. Eg- magic



•   A general feature of the preoperational period is
    ‘egocentrism’, that is the child is incapable of

    assuming another person’s point of view.
Eg:-

•   He will follow instructions if he explained       that
    brushing will make his teeth feel clean and smooth.

    Toothpaste makes mouth taste good.



    Because these statements rely on things the child
    can taste or feel immediately.
•   Another feature preoperational period is ‘animism’.
    Everything is seen as being alive by a young child.



•   Animism can be used to the dental team’s
    advantage by giving dental instruments and
    equipment life like names

    e.g., hand piece can be called ‘whistling Willie’.
•   Eg:- To motivate a child to stop thumb sucking we
    can animate the child’s body part as ‘Mr. Thumb’
    who is causing problem and that the dentist and the
    child should form a partnership to control Mr. Thumb
    who wishes to get into child’s mouth.



•   At this stage, the child’s logical reasoning
    capabilities are limited. So it can feel immediate
    problems better than concepts like prevention.
-Muller layer illusion deference in 4year / 8year




5-6 year old children showed surprise Primitive identity
concept
            Concrete operation stage
•   As a child moves into this stage, an improved ability to
    reason emerges.



•   Child can use a limited number of logical processes,
    especially those objects that can be handled and
    manipulated.



•   Child develops ability to see another point of view
    develops, while animism declines.
•   However, if the child is posed with a problem stated
    only in words with no concrete objects to illustrate it,
    the child may fail to solve it.



•   Presenting ideas with illustration with concrete
    objects can be a better way to communication.
•   wear your retainer every night. is too abstract an
    instruction.



•   More concrete directions would be “this is your
    retainer, put it in your mouth like this and take it out
    like that. Put it in every night right after dinner before
    you go to bed and take it out before breakfast every
    morning. Brush it like this with an old toothbrush to
    keep it clean.
                Formal operation stage

•   Ability to deal with abstract concepts and reasoning
    develops by this stage and the thinking process is
    somewhat similar to the adult.



•   Children at this stage are in a new expression of
    egocentrism and are concerned about their looks,
    actions, feelings.
•   Children at this stage develop phenomenon called
    the ‘imaginary audience’ ( Elkind.)



•   They feel as though they are constantly ‘on stage’
    being observed and criticized by those around them.



•   This make them quite self conscious and particularly
    susceptible to peer influences.
•   As a result of this thought a second phenomenon
    emerges, called the ‘personal fable’ (Elkind).



•   This concept holds that because I am unique, I am
    not subject to the consequences others will
    experience.



•   The personal fable is a powerful motivation that
    allows us to cope in a dangerous world.
•   Both the imaginary audience and the personal fable
    have useful functions in helping us develop a social
    awareness and allowing is to cope in a dangerous
    environment.

•   They may also lead to dysfunctional behaviour.



    e.g., Imaginary audience to wear or not to wear
    appliances.

    The personal fable – Ignorance of decalcification poor
    oral hygiene.
               Classical conditioning

Russian psychologist Petrovich Pavlov

•   First study in conditioned reflexes experimentally

•   Respondent conditioning or Pavlovian conditioning.



•   Crucial element of the conditioning is the
    relationship between the conditioned stimulus and
    the unconditioned stimulus.
              Stimulus substitution

•   Pavlov thought that 2 areas of the brain, one for the
    CS and one for the US.

•   According to him link up takes place in the brain
    between CS and US .



•   CS became activated during the conditioning
    procedure and that activation of the US area
    resulted in reflex response.
             Information and expectation


•   According to these theories CS becomes a signal for
    the US

•   CS event consistently found in the memory



•   An association or link is thus formed in the memory
    and when the CS occurs, US is expected naturally
Principles involved in classical conditioning

Generalization/stimulus generalization



According to it, a child will tend to generalize the
conditioned response to other stimuli that were
somewhat similar to the original conditioned stimulus.
•   The development of irrational fears or phobias by
    children.



    E.g., A child who has had a painful experience with
    a doctor in a white coat always associates any
    doctor in white coat with pain.
Extinction

•   Pavlov thought of conditioning in terms of two
    opposing tendencies excitation and inhibition.



•   During acquisition, the excitatory tendency has the
    upper hand.



•   During extinction, inhibition builds up to suppress
    conditioned responding.
•   Extinction of the conditioned behaviour results if the
    CS and US is not reinforced.



•   An example of extinction is that if a child with an
    initial   painful   experience   with   a   doctor,   on
    subsequent visits to a doctor without any unpleasant
    experiences results in extinction of the fear.
•   The decrease in the conditioned response
    magnitude resulting from extinction need not be
    permanent.



•   As if the subject is again exposed to the initial
    conditions.



•   The magnitude of the acquisition will probably be
    much greater than it was at the end of extinction the
    day
•   An decease in the magnitude of a conditioned
    response after a period of time with no explicit
    training is known as spontaneous recovery.



•   The phenomenon of spontaneous recovery shows
    that the extinction procedure
                    Discrimination

•   It is the process of learning to make one response to
    one stimulus and a different responses to deferent
    stimulus.



•   For example if the child is exposed to clinic settings
    which are different to those associated with the
    painful experiences the child learns to discriminate
    between the two clinics.
     Significance of classical conditioning

•   A face, a scene or a voice can act as the
    conditioned stimulus for an emotional response.



•   We may not be at all times able to identify the
    original of a child’s emotional response, however
    extinction and discrimination may help as one of the
    behaviour therapy technique.
principles of classical conditioning can be used in

       Developing good habits

       Breaking     habits      and     elimination   of
       conditioned fear.

       Psychotherapy to de-condition emotional fear

       Developing positive attitudes.

       Teaching alphabets.
                Operant conditioning

B.F. Skinner

Instrumental conditioning

•   Extension of classical conditioning.



•   when a response operates on the environment, it
    may have consequences that can affect the
    likelihood that the response will occur again.
         Types of operant conditioning


•   Skinner described four basic types of operant
    conditioning



•   Reinforcement – which can be + /-

•   Omission

•   Punishment
                    Reinforcement

Event that is the consequence of an instrumental
response more likely to occur again is known as
‘reinforcer’ or ‘reinforcement’.



Positive reinforcement

A positive reinforcer is a pleasant stimulus or event in
form of reward or praise following a response
reward or praise made for good behaviour following
dental treatment acts as a positive reinforcement and
makes the likelihood that the good behaviour of the
child will continue.
Negative reinforcement



A negative reinforcer is a stimulus or event which, when
stoped increases the likelihood that the response will
occur again.
Negative reinforcers are often (but not necessarily)
painful or noxious events.



E.g., HOME used in treatment of children.

      Mild electric shock
            Omission of reinforcement

•   This refers to withdrawal or removal of a pleasant
    response (positive reinforcer) after a particular
    response.



•   The effect of the omission of the reinforcement is to
    decrease the likelihood of the response that led to
    the removal of positive reinforcement.
•   For example, if the child misbehaves during the
    dental treatment his favorite toy is taken away.



•   For a short time or saying that his parents will be
    turned out of his sight result in the omission of the
    undesirable behavior.
                        Punishment

•   A punisher is a stimulus or event which, when its
    started decreases the likelihood that the response
    will occur again.



•   punisher is quite different from negative reinforcer,
    while both are often noxious events.
•   Responses followed by punishers tend not to be
    repeated,   while   those   followed      by   negative
    reinforcers tend to become more likely.



•   palatal rake in correction of tongue thrusting habit.
    One mild form of punishment
•   Positive and negative reinforcements are the most
    suitable types for a dental treatment while the other
    two types should be used with caution.
                 Hierarchy of needs

Masler (1954)

•   Self-actualization theory

•   He studied models of self actualized people

    people from history Abraham Lincoln, Thoreau,
    Rossevelt. Einstein, Beethoven, a successful
    housewives and his friends.
He found that the character of self actualized people is

as follows

  True with themselves

  Spontaneous, independent

  Devoted, dedicated, creative

  Related to few special loved one.
•   The needs are arranged in a hierarchy

•   The desires from most basic biologic needs to the
    more psychological need emerge after basic needs
    have been satisfied.



•   Motivation is constantly required



•   Pain avoidance, tension reduction and pleasure act
    as sources of motivating behavior.
       Self
    actualisation

     Esteem

     social

    Security

Psychology of needs
              Social learning theory

Bandura (1963)

• Most complete, clinically useful and theoretically a
  sophisticated

• learning of behaviour is affected by 4 principle
  elements

Antecedent determinants: aware of what is occurring.

Consequent determinants: perception and cognitive
  factors determine behaviour.
Modeling: Learning through observation eliminates the
trial – error search.



Self-regulation: This system involves a process of self
regulation, judgment and evaluation of individual’s
responses to his own behaviour.
  Age      Sigmond freud                   Erickson               Jean Piaget
        Psycho physiologic --------------------------- ----------------------
        emergency
Birth   Trust/Anxiety



        Oral satisfaction           Proper mothering    Reflex activities
        Trust/Oral fixation         Trust/ Mistrust
0-1                                 Sense of confidence sensory, motoric
                                    Separation          development


        -------------------------   --------------------------- Language
                                                                Schemas
1-2                                                             Plastic reflection
 Age    Sigmond freud              Erickson         Jean Piaget
       N-M                  Terrible two
2-3    development          Motor development
       Voluntary            Autonomy/shame        Symbol language
       Control              Self esteem           Solve problem
       Independence/        Non separation        Can’t say why
       Shame                Sedation
       Gender               Initiative, curious
       Identification       Initiative / guilt    Egocentrism
4-5    Differentiation in   Sense of purpose      Animism
       sex role occurs      Introduction
                            separation
       Self inner control Completing tasks       Reasoning
       Develops           Industry / inferiority Logic thinking
6-12   Matured Skilled Sense of competence Illustrations
                          Peer group /active R
 Age      Sigmond freud               Erickson               Jean Piaget
        Sense of identity      Parent separation         Abstract concepts
        Mature behaviour       Peer influence            Imaginary
13-18                          Identity/ confusion       audinance
                               Sense of                  Personal fable
                               consistency
        ------------------------ Compromise              ------------------------
Young   -                        Sacrifice
                                                         -
adult                            Intimacy /isolation
                                 Sense of relation
        ------------------------ Parent, citizen         ------------------------
Adult   -                        Generativity/
                                 Stagnation
                                 Sense of care
Late    ------------------------ Ego integrity/despair ------------------------
adult   -                        Calm death
Development of child
    psychology
                    Development


Development comprises all the normal sequential series
of events which results in the increased complexity or
maturity in the course of natural progression from a
single cell to the multifunctional organism ending at
death.
Child development includes

            Biologic

            Cognitive

            Emotional        Psychology

            Social

                             Behaviour
Biologic development

• Increase in height weight

• Motor maturation

• Development of bodily control

• Maturation of gross and fine motor skill

• Crawling, walking, running, climbing stairs

• Holding blocks
NB   10-11 week   5-6 months           1- 1.3year




 16-24 week              8-10 months
Psychological development - is a dynamic process.



It begins right at birth, continues to develop through
sequential stages which is expressed as various
characteristic behavior.



These stages proceed in an orderly step like fashion
each representing a higher level of function.
At each stage there are certain kinds of problems to be
solved and when the child succeeds he can dose go on
to tackle new problems and grow through solving them.




Genetic, familial, cultural, interpersonal and inter
psychic factors.

Thus the achievements of each stage are built on the
foundations of previous stage.
                      Neonate

Neonates born with ability to sense and respond to
some stimulus organized and effective way called
reflexes

Moro reflex
Startle reflex

Grasp reflex

Gag reflex 18 weeks of IUL

Babinski’s reflex

Infantile swallow

Vomiting reflex

Withdrawal reflex
Rooting reflex and sucking




Swallowing 12th week of ILU

Swallowing and suckling 36th week of ILU
Perceptual ability

  Taste differentiation



Visual ability ( Haith 1976 rules)

  If I am awake and light is not bright I will open my eyes

  If the area I am looking is dark I will begin to search for
  shadow

  In normal light I find an edge if I find I keep looking at it

  If no edge found I will be board I may cry
Eye movements of 3 new born babies
                       Imitation

Babies as young as 2- 3 weeks can mimic certain adult
behavior (moor 1977)
            Birth to I year (cognitive)

For newborn infant world,society and to the family are
strange.



So his first task is to adapt his physiologic function with
his care takers, through some kind of interactions.



This process is called as homeostasis.
Successful interaction during the 2 to 3 months of life
results in equilibrium, regular patterns of eating and
sleeping and a feeling of trust on the part of the mother.



Some times equilibrium is not achieved due to difficult
baby or inexperienced mother resulting in hard time

for baby-mother pair. Difficult baby Syndrome
This stage is same as sensory motor intelligence stage
of cognitive theory.



SMI uses no language or symbol it works on cry,
perception, movements.



The main type of interaction of baby at this stage is
through cry.
Cry is the expression of the new born’s feeling of
inferiority to reality (Vien adler)



Cry can be reliably differentiated as early as from first
day of birth ( Bryan).
•   In pain cry gradually raised in pitch that changes
    with sustained stimulation.



•   When wet utters short staccato cries punctuated
    with short intervals of silence.



•   When anger gulping slobs are heard
First 3 months for adaptation to extra uterine life



With good homeostasis, successful physical growth
provides sense of trust feelings of security that last
through out life.



Infancy -the first critical and most crucial period for
psychic growth
From 3rd month baby starts to build more and more
complex schemas.



Schema of the permanence of objects, people,
environment.



It believes that the object continues to exist even though
it is hidden or placed in a new relation.
Then child learns to control the movements in space
which gives the child a further sense of separateness
from the mother and a trust in his own body.



Increased motor development crawling walking also
helps child to feel sense of separation.
Development of perception

Visual perception

  1st month – edge, point no human face

  2nd month- focus on internal anatomy of face

  5rd month- can see assembled face

  6th month can differentiate two faces
Depth perception

  Explained by Gibson walker test

  6-14 month
                Social development

First social relation ship with parents

Bowlby (1966) experimented in nursery and hospital.



The infant should experience a warm continues and
intimate relation ship with primary care taker to obtain a
good psychic health.
•   0- 2month in general human proximity

•   2-6 month Keep proximity with familial faces

•   6-9 month develop true attachment with mother

•   1 year attachment become so strong that child react
    negatively to separation

Lamb 1976 experiment of child parent relation reaction
    in presence of stranger.

At the time of stress child orient mother at play time to
    father.
Contact comfort

It acts as stress releaser

Helps to develop attachment.
                       1 to 3 year

child perfects his motor skills

       learning to move independently.

       hold a crayon to produce marks and pictures.



At about the second year Objects differentiation and
orderly arranging schema develops .
The child can now

(1) make his wants known,

(2) increase his sense of self by using his name,

(3) use language to group objects



Development of a sense of autonomy or shame.

Clear and firm restrictions obeys
                Social development

three phases

1)   Separation due to increase motor and language
     skills

2)   intense reproaching phase (18 months)

     experiencing real separation anxiety

3)   development of autonomy and self-regulation,
     fostered by the parents.
"security blanket“

intense attachment to a special toy or blanket

child clings to it, drags every where, and will not go to
sleep without.



It signifies a transitional period stepping-stone from the
relationship with mother to relationships with other
people.
            3 to6 -the preschool years

• Development of a sense of initiative and imagination

• Imagines himself in a variety of roles

• Seeks reasons, answers, solutions, and new ideas

• Aggression and assertive behavior develops

• Child internalizes the parents' expectations

• Child feels guilty
The forces of creativity and social control struggle in the
young child,

With his imagination he can easily hit or kill people who
oppose him

Create monsters to eat the people. However, the
monsters may get out of control and threaten him
(especially in a dream).
             Language development

Language development is more discontinues stage like

Stages of development



Before first real word child often communicates with
parents by using private expression
By first birth day starts speaking

By age 2 vocabulary expand to 50 words

By age 3 1000 words

By age6 8000 - 14000 words



Holophrase importance
Generalization of grammar develop at 3-4 year

This is self correcting with more amount of conversation
and age
Child really can not under stand the deference
                Social development

Parent child relation

  separation seen

  disciplines inhibitions taught by parents


Parental style in this age affects child behavior
Authoritative parent -child friendly curious, energetic,
self reliant



Permissive parents- Less self reliance, poor self control,

Impulsive, aggressive



High control Authoritative parent-apprehensive with
drawn unhappy distressful.
Sex role

Not identifiable till 4years

By 4and half years child develops principle of identity

by observational learning
Peers and play

Child to child interaction

  Initially solitary play birth to 1 1/ 2 year

  Parallel play 2-3 years

  Cooperative play 3 years but no constant play mate

  Pretended play faith full friend at 3-4 years

  Gender identification 4-5 yeras
Intimate peer relationship seen in children with out
parents
          Ages 6 to 12 -the school years


By this time has achieved enough trust, autonomy, and
initiative to involve in the private world of children,
where adults are often unwelcome.



This peer group with whom he compares himself and
seeks acceptance from.
•   Development of a sense of industry or duty and
    accomplishment

•   Mastery and achievement are key words for the
    school-age child.

•   Child also develops a sense of inferiority and
    inadequacy, feel low self-esteem.

•   Acquire mathematical skills

•   Thinks logical thought processes
               Social development

Social world expands with class mates teacher

Person perception 6-7 year

  physical appearance

  out ward behaviour

Next stage child explains persons psychological
  character 9-10 years
Friendship

Person perception helps child to select change friends

Reciprocal friendship develops

  do things for each other

Usually of same sex

Groups

Friends organize them selves in to groups

Groups has certain definite characteristics

Goals shared by members, follow a rules
Emotional development
     commonly seen emotions in a child


Distress or Cry

• Primary emotion present at birth.

• At preschool due to physical pain.

• School years crying habit decreases rapidly till 15
  years.

• In young adult during intense emotions / grief.
         Types of cry seen in children

Elsbach, 1963

• Obstinate Cry

      Temper tantrum

      Loud, high-pitched

      Siren like

      Child's external response to anxiety.
• Frightened Cry

      Accompanied by a torrent of tears

      Convulsive breath-catching sobs

• Hurt Cry

  Initial discomfort

      Tear filling from eye and running down the cheek
       With out sound

  Later discomfort

      loud ,Accompanied by a small whimper.
• Compensatory Cry

     It is not a cry

     Sound that child makes to divert the noise

     Monotone

     Coping mechanism to unpleasant auditory
     stimuli, uncomfortable situation.
                        Anger

• Birth to 5 months expressed by cry
• 5 months child throw objects

• Two year olds attack other children to hurt

• Four years old express through begging

• Five years old less expression

• Six years old violent methods of expression
• Seven year ones display more aggressiveness,

      though kicking, throwing objects.

• 8-9 years old's anger is expressed through feelings.

      It becomes directed towards a single person.

• 10 - 12 years old's anger may become violent and

      may be expressed physically and verbally.

• 14 years olds may take out his anger on some one
      else.
                          Fear

• Prevalence of Fear 3-21 % depending on the age

• Prevalence of Fear is more in Girls than boys.

      An inherent timidity in girls.

      Girls display fear while boys hide it.

• Fears increase from infancy to young childhood
                Development of fear

At birth

• Response acquired soon after birth with out knowing
    stimulus

• With age reason for stimuli known



Preschooler (2-5 years)

• Fear of animal, left alone or abandoned

•   More apprehensive about failures
Early schooler

• Fear of the dark, staying alone

• Show fear of ghosts and witches, war, beggars



Late schoolr

• By age of 9, fear of bodily injury may be

    present.

•   Fear of failure, competition, punishment

•   Fear of crowds,heights
Adolescent

• Fear of social rejection and fear of performance

  (peer group pressures, academic )
                    Types of fear

Innate fear - without stimuli or previous experience

Subjective fear- Fears transmitted

      family member, peer (friends)

      information media (TV, papers, comics).



Objective fear : Fears due to past experience

       Previous (dental trauma)

       generalization (medical experience).
Physical Dental Stimuli

• Aesthetic administration locally by injection.

• Extraction.

• Sound of drill.

Psychological Dental Stimuli

• Fear of pain or its anticipation.

• lack of trust.

• Fear of the unknown.

• Fear of instruments.
Symptoms of Intense Fear

Unpleasant feeling , cry or hide, increased heart rate,

tense muscle , dryness of mouth, sinking feeling



Physiological Sign of Fear

       Pale sweaty skin.

       Dilatation of-pupils. ,

       Increased heart-rate, breathing, blood pressure.
Response to fear

• Intellectual level: child accepts the situation and face
  the difficulties (seen at adolescent age).



• Emotional level: child shows the fight or flight response,

  (seen in school age).



• Hedonic level: self centeredness, may or not accepting
  depending on comfort of treatment (seen in a very
  young.)
              FEAR ASSESSMENTS

(Klingberg, 1994)



• The dental setting pictures

• The pointing pictures

• A sentence completion task
            The dental setting pictures
  Contain a set of ten pictures (A4 size papers) of
  animals

  Encouraged to tell a story about each picture.



• A baby bear brushing his teeth in the
  bathroom,supervised by an adult bear.

• A puppy and an adult dog walking in the street,one
  of the houses in the street' accommodates a dental
  office.
• A baby lion and an adult lion in the dentist's waiting
  room.

• A baby bear' shaking hands with the dentist.

• A baby cat sitting alone in the dental chair.

• A bear lying in the dental chair, opening his mouth

  wide. and looking at the dental instruments.

• A dentist examining the teeth and holding
  instruments in the mouth of a puppy.
• A dentist drilling a tooth of a puppy, dental assistant
  standing beside the chair.

• A dentist giving a dental hygiene instruction to a

  kitten.

• A puppy being rewarded by the dentist after the

  treatment.
                The pointing pictures
  Contain a set of five pictures (A4 size papers)
  showing a (human) child.

• Just before going to the dentist

• The dentist examining the mouth

• The dentist giving an injection

• The dentist drilling

• Lying in bed about to fall asleep/dreaming about

  dentists.
      a) very happy -1

      b) feeling somewhat afraid -2

      c) feeling very much afraid-3

      d) feeling very very much afraid.-4



Final added to check reaction
              A sentence completion task


contains fifteen incomplete sentences



The child is instructed to complete the sentences by
saving the first word or words that come to mind.



Display of virtual realities
                         Anxiety


• Is an unpleasant feeling similar to fear I.e. Is a
 reaction to unknown danger.

• It develops later than fear.



Types of anxiety

 Trait anxiety, State anxiety, Free floating anxiety,
 Situational anxiety, General anxiety
Anxiety Rating Scale
2 -Feeling scared but cooperative 3- Feeling scared will not
                                            cooperate
4- very scared un cooperative physical restrains required
                          Phobia

• Irrational fear to specific object, activity or situation.



Most common phobia in childhood

  Zoo phobia (2– 10)

  Darkness (4 –6 years)

  School phobia (11-12)

  Dental phobia       (12)
Acrophobia           Height

Agoraphobia          Open space

Arachnophobia        Spider

Anthropophobia       People

Aquaphobia (hydro)   Water

Astraphobia          Lightening

Claustrophobia       Closed space

Cynophobia           Dog

Zoophobia            Animals

Nyclophobia          Darkness

Pyrophobia           Fire

Xenophobia           Stranger
Child behaviour in dental clinic
Classification of child's behaviour observed
                in dental clinic



Wilson’ s Classification 1933

  Normal /bold

  Tasteful /timid

  Hysterical / rebellious

  Nervous / fearful
Frankel’s classification 1962

1 definitely negative - Refuses treatment, cries
  forcefully associated with fear

2 negative- Resist to accept treatment

3 positive- Accepts treatment, but if the child has

  a bad experience during treatment, may become
  uncooperative.

4 Definitely positive- Unique behavior, understands the
  importance of good preventive care
Lampshire (1970)

Co- operative : The child is physically and emotionally
relaxed. Is co-operative throughout the entire procedure.



Tens co-operative: The child is tensed, but cooperative



Outwardly apprehensive: Avoids treatment-initially,
usually hides behind the mother, avoids dentist.
Eventually accepts treatment.
Fearful: Requires considerable support to overcome the
fears



Stubborn / Defiant: Passively resists treatment



Hyper motive: The child resorts to screaming kicking



Handicapped: Physically / mentally,

Emotionally immature
Wright (1975)


A) Cooperative (positive Behaviour)

  a) Co operative Behavior



  b) Lacking cooperative ability

      young child, (0-3 yrs.), disabled child, handicap.
c) Potentially co operative

  Due to inherent fears (subjective/objective) the child
  does nor-cooperate. Eventually cooperate,
B) Un cooperative.-(Negative Behaviour)

•   Uncontrolled / Hysterical-

    physical resist loud crying

    Temper tantrums.

•   Defiant behavior / obstinate behavior

    spoilt or stubborn children.

•   Tense co-operative

    These children are the borderline between positive
    and negative behavior.
• Timid behavior/shy

   shy but cooperative

• Whining type:

   allows for treatment but complains throughout the
  procedure.



• Stoic behavior: Seen in physically abused children.
  They are cooperative and passively accept all
  treatment without any facial expression.
  Factors affecting child's behaviour in the
                 dental office
Under the control of the dentist

Dental clinic

• warm / homely environment. decrease anxiety.

• Color full operating room

• separate waiting room with separate exit

• Dental auxiliary should be kind ,Smiling

• Early morning, 30 min
Dentist

• Good impression

• Avoid jerk / quick movements

• Be flaunt in words /actions

Child can become cooperative to dentist by (Jenks1964)

• Data gathering and observation

• Structuring ---Same language, same level

• Externalization --- involvement / distraction
• Empathy and support -- Under stand feeling of others

• Flexible authority – Compromise made by dentist to
  meet needs of patient

• Education and training



Dental attire--- To prevent fear

Pre school / handicapped children –Presence of parent

Presence of an older sibling --- Role model

                            4 year pt max effect
Under the influence of patient

Growth / development

• Normal physical growth / Mental retarded/ cerebral
  palsy /Handicapped child

• Very young child

Nutrition

• Increased sugar intake -- Irritable behaviour

• Hypoglycemic – criminal behaviour

• Skipping break fast – Impaired performance

• Nutritional deficiency
Past medical or dental experience

Genetics

School environment --- 50% children affected

Socio economic status – High - Spoilt

                        Low - Tensed
 Family and parental influence on behaviour


Home environment

• Broken family

• Internal family conflict --- Insecure inferior apathic
  depressed

• Position and status of the child in the family

• Sibling behaviour and there influence
     Parental influence on child behavior

Over protective        shy, submissive, anxious

Dominant



Over indulgent         aggressive, demanding



Rejecting              aggressive, overactive,

                        disobedient
Under affectionate   well behaved, unable to
                     cooperate, shy, cry easily



Authoritarian         Evasive and dawdling
Over protective mother

•    Exaggeration of love and affection

•    The child is totally dependent.



Causes of overprotection:

a.   Late pregnancy

b.   Only child.

c.   Sick child / handicapped child.

d.   financial reasons
Features in child

• He develop no initiative-ness or make decisions for
    himself.

• The mother takes active part in his social activities.

• The child does not cope with the problems and
    anxieties of life.

• The child is submissive, shy, anxious and fears new
    situations, lacks in self-confidence.

• These children will not create a good rapport

•   They are polite, obedient, disciplined.
Management

• Create self-confidence in the child

• Familiarize the child with the clinic, and the

  dentist's auxiliaries

• Tell-show-do technique
Over protective - overindulgent mother



• The child is aggressive, demanding, display anger

• These children expect constant attention and services.

• They are obstinate, stubborn, spoilt.

• These children will try to dominate over the dentist

• These children are well behaved and well adjusted

• Dentist will be unable to establish a good relation with
  the child.
Under affectionate mother

child is devoid of love and care.

Under affection varies from mild detachment to neglect



Causes for under affection

  a) Unwanted child

  b) Hampers the mother's career and ambitions

  c) Unhappy mother

  d) Emotional problems
Features of the child

• The child be well behaved and well adjusted.

• They are shy and wont easily establish a good
  rapport

• Uncooperative to dental treatment.
Rejecting mother



Neglect manifests as

• Physical punishment, violence, especially in the
  uneducated mothers. Battered baby syndrome.

• Refusal to spend time / money with the child

• Neglect child's health

• Emotional and physical neglect
Features of the child

• Over reactive, aggressive, disobedient .

• Tries to gain attention of others by showing overt
  behaviors

• Lack of self-esteem

• They are most difficult to deal in the clinic

• Emotionally insecure.
Authoritarian mother

• The mother is very authoritarian and has got certain
    norms for the child to follow.

•   Norms vary from physical abuse to verbal ridicule.

Features of child

• Dawdling child, obeys commands slowly and with
    delay.

• Parents are not supportive to the child and rather
    criticize them.
Dawdling child, obeys commands slowly

and with delay.

Parents arc not supportive to the child and rather
      criticize them.
Management

• Develop confidence in the child by showing Tender

  Love and Care.

• Meet their demands as soon as possible.

• Create self-confidence in the child.

• Familiarize the child with the clinic, and the

  dentist's auxiliaries.
Thank you

				
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