CHILD PSYCHOLOGY & THEORIES

CONTENTS

 INTRODUCTION

 HISTORY OF CHILD PSYCHOLOGY

 DEFINITION

 THEMES IN THE STUDY OF HUMAN DEVELOPMENT

 FACTORS AFFECTING PSYCHOLOGY OF CHILDRENS

 IMPORTANCE OF CHILD PSYCHOLOGY

 THEORIES OF CHILD PSYCHOLOGY

 CLINICAL IMPLICATION

 CONCLUSION

 REFERENCES
INTRODUCTION

 Children are not small adults but developing individuals during childhood, little attention
was paid to the many advances in cognitive abilities, language usage and physical
growth.

 Psychologic growth and development generally proceed in a relatively predictable,

logical, step-like sequential order.

 These processes are influenced by genetic, familial-cultural, inter-personal and intra-

sychic factors

HISTORY

 In late 1700, Frans Tesmer, an Austrian Physician, practiced Mesmerism later modified
and renamed as Hypnosis

 G. Stanley Hall (1890) is often referred to as "The father of child study movement“.

 19th Century – Darwin proposed the concept of psychological adjustment

 Later , Mendel’s work on genetics promoted study of children theory

 Eugen Blueler (1857 -1939), a Swiss psychiatrist further studied and renamed dementia
as Schizophrenia

 The 20th century was influenced by "Sir Sigmund Freud", who is the founder of modern
psychiatry. He practiced of psychoanalysis and formulated theories in Psychoanalysis.
1905 - Freud influenced the concepts of psychology

 Carl Song, Alfred Adler, Otto Rank, Erik Erikson, Anna Freud and Karen Homey, Jean
Piaget, John Bowley are other psychoanalysts who became influential in the history of
psychology and psychotherapy

 Later Harry Stack Sullivan, an American founded a school of psycholoanalytic

psychology, focusing more on interpersonal stimulus.

 1913 - Watson’s Behaviorism - Watson’s treatise on emotional conditioning in infant’s

influenced early child care and training
 1927 – Russian psychologist , Ivan petrivich Pavlov developed experimental techniques
for studying learning, reflexes experimental in dogs

 1933 – Mahler’s theory of personality development

 1938 – Extension of classical conditioning – operant conditioning by skinner.

(Reinforcement or extinction of previous responses)

 1950 - Piaget defined intelligence as a basic life process that helps an organism adapt to
its environment.(Cognitive theory)

 1954 –Maslow Hierarchy of needs – self actualization theory

 1963 – Erik erikson – Entire span of life from infancy to childhood

 1979 - Bronfenbrenner’s Contexts for Development (The microsystem refers to relations

between the child and the immediate environment, the mesosystem to connections among
the child’s immediate settings, the exosystem to social settings that affect but do not
contain the child, and the macrosystem to the overarching ideology of the culture.
THEMES IN THE STUDY OF HUMAN DEVELOPMENT

The Nature/Nurture Theme

 Human development primarily the result of nature (biological forces) or nurture

(environmental forces).Heredity and not by a environment is the chief maker of man.

The Active/Passive Theme

 Another topic of theoretical debate is the active/passive theme. Are children

curious,active creatures who largely determine how agents of society treat them? Or, are
they passive souls on whom society fixes its stamp?

Continuity / Discontinuity theme

On one side of this continuity/discontinuity issue are continuity theorists who view human
development as an additive process that occurs gradually and continuously, without sudden
changes. They might represent the course of developmental change with a smooth line of growth.

DEFINITION

PSYCHOLOGY -Science dealing with human nature, function,and phenomenon of his soul in
main

CHILD PSYCHOLOGY - Science or study of child’s mind and how it functions. It is also the
science that deals with mental power or an interaction between the conscious and subconscious
elements in a child. Child psychology is the scientific study of children’s behaviour and
development.

According to J B Watson (1949) “Psychology is a science of human behavior". Later he modified

and stated Psychology is a science of human and animal behavior".

According to Clifford T. Morgan “Psychology is a science of human and animal behavior. It

includes the application of this science to human problems".
 EMOTION - An effective state of consciousness in which joy, sorrow, fear, hate likes are
expressed

BEHAVIOR - Any change observed in functioning of organism.

FACTORS AFFECTING CHILD’S PSYCHOLOGY

PARENT-CHILD It combination of behaviors, feelings, and expectations that

RELATIONSHIPS are unique to a particular parent and a particular child

PARENT-INFANT One of the most important aspects of infant psychosocial

ATTACHMENT development is the infant's attachment to parent. It based on a
strong foundation of attachment

CHARACTERISTICS Parental self-confidence , Parental age and Previous experience

OF THE PARENT - Older mothers tend to be more responsive to their infants than
younger mothers.

CHARACTERISTICS Child's physical appearance, sex, and temperament. At birth, the

OF THE CHILD infant's physical appearance may not meet the parent's
expectations, or the infant may resemble a disliked relative. As
a result, the parent may subconsciously reject the child. If the
parents wanted a baby of a particular sex, they may be
disappointed if the baby is the opposite sex.
MATERNAL ATTITUDE AND CHILD’S BEHAVIOUR
 PARENTAL INFLUENCE ON It is difficult for a child to grow to adulthood without
CHILDREN’S experiencing some form of gender bias or
SOCIALIZATION TO GENDER stereotyping, whether it be the expectation that boys
ROLE are better than girls at math or the idea that only
females can nurture children
(DIRECT INTERACTION, IDENTIFICATION,
AND TRANSMISSION OF FAMILY STORIES)

SOCIOECONOMIC, Middle-class parents - dental care readily and

CULTURAL AND ETHNIC cooperatively.
INFLUENCES
Attitudes of parents - Parents from lower income
groups demonstrate more authoritarian and
controlling behaviour .

Cultural and ethnic - weaning practices, digit sucking

habits, oral hygiene practices and their seeking of
professional dental care. Ethnic differences lead to
dissimilar child-rearing practices

IMPORTANCE OF CHILD PSYCHOLOGY:

 To understand the child better

 Deliver dental treatment effectively

 Effective communication

 Gain confidence of child and parent.

 Teach importance of primary and preventive care

 Better Treatment planning

 For a comfortable environment for dental team to work.

PSYCHOLOGY THEORIES

A) Theories on emotional /Psychodynamic development

1. Psychosexual/ Analytic Theory- Freud(1905)
2. Psychosocial Theory- Erik Erikson(1963)
3. The Theory Of Hierarchy Of Needs-by Abraham Maslow
4. The Theory Of Separation – Individualization- By Margaret Mahler
B) Theory On Cognitive Development
1. Cognitive theory- Jean Piaget(1952)
C) Theories of learning and developing behaviour
1. Social Learning Theory- Bandura(1963)
2. Classical conditioning- Pavlov(1927)
3. Operant Conditioning- Skinner(1938)

 1905 - Sigmund Freud was an Austrian neurologist who founded the psychoanalytic
school of psychology

 Freud is best known for his theories of the unconscious mind and the defense
mechanism of repression and for creating the clinical practice of psychoanalysis .

 Archaic Discharge Syndrome

 Psychosexual

 Psychoanalytic Theory
ARCHAIC DISCHARGE SYNDROME

 This theory was put forward by “SIGMUND FREUD” (1856-1939); who has been called
as “Father of Modern Psychiatry”; in the year 1939.

 It suggests that human body contains 2 types of neurons which are

 Psi neurons -> for storage of emotions and

 Phi neurons -> for conduction of emotions.

 When the stored emotion reaches a certain level, a discharge is sparked off leading to
overt displays of emotions.

Freud psychoanalytical theory two models ,

 1)Topographic model

 2)Psychic model / psychic traid

Topographic model , human mind consists of conscious , preconscious and subconscious mind

a) Conscious - Paying attention at all moments

b) Pre conscious –Ordinary memory & knowledge

c) Unconscious - Process and content are out of direct reach of conscious mind Iceberg –
1% of iceberg only visible( Conscious) ,90% - not visible- unconscious mind.

PSYCHIC TRIAD

According to Freud ,what humans do, why they do it, what and how humans are largely
determined, during first few years of life during which the person develops internal drives and
conflicts.

 Difference in personality originate from difference in childhood sexual experiences.

 The structure of personality is composed of 3 mental structures the Id, Ego and
superego(Psychic triad).
 ID EGO SUPER EGO

Portion of mind that contains The conscious and The Super-ego aims for
unconscious drives for pleasure and reality oriented perfection.
destruction portion of mind
It contains moral principle
The Ego acts and values,acquired from
according to the parents.
reality principle
rather than pleasure
principle

The id acts on pleasure pain principle - Responsible for Policeman of the 3

selfishness and instant self- childs capacity for ,monitoring the right and
gratification. self awareness wrong

Defined as the inherited reservoir of It helps id to obtain 2 subparts

unorganised drives ,mostly real rather than
1) moral prohibtion against
unconscious, is governed by the imaginary
certain behaviors,especially
pleasure pain principle ,aims at satisfaction,
sexual and aggressive
immediate satisfaction of libidinal
It has Perception of drives of id
urges ,is immoral, illogical,and lacks
both internal and
unity of purpose. 2) Ego ideal-it’s the image
external world
of what one ideally can be
and how one ought to
behave.

Erogenous zone

 At different ages of life ,human beings feel tension most intensly in different areas of
body.

 These areas require pleasure producing stimulation to reduce or eliminate tension.

 Concept of fixation

 Failure of development in which the individual continues to seek a particular kind of

gratification even after he or she has passed through the stage in which that kind of
pleasure is normally sought.

PSYCHIC STRUCTURE

Pleasure principle
ID Immediate gratification
Impulsive, primary,
inborn

Reality principle
EGO
Acceptable way to satisfy
the Id
Deliberate, rational

Perfection principle
Internal censor
SUPER Judgmental,
EGO Internalized standard
ORAL ( BIRTH TO 18 MONTHS) ANAL (18month-3 to 4 yrs)

 Mouth is the most sensitive  Locus of gratification shifts to anal region,either

zone.(Erogenous zone – from movement or withholding movement of
where the we seek or gain bowels.
pleasure)  Retaining or elimination faeces.
 Nursing-eating , biting,  Discover their ability to control such
sucking,pacifier or keeping movements.
objects in mouth, by which
tension in and around mouth
is reduced

Insufficient feeding or forcefull Age of toilet training.

feeding result in fixation

Symptoms of oral fixation are Symptoms of anal fixation

chewing habits pencil, nailbiting,  Anal expulsive personality shows
excessive eating , smoking excessivesloppiness,disorganized,reckless and
careless behaviour
  Abundant oral stimulation If strict – Neat in adulthood ,Anal retentive personality
may result in oral passive shows obssesively cleanly and orderliness
individual.
 Lack of oral stimulation result
in an oral aggressive
individual

PHALLIC(3 to 4yrs to 6 yrs)

Age 3 to 4 years ,during which genitals become the most sensitive area and child derives pleasure
by manipulating them.
Most challenging stage,

children develop feeling of attraction toward parent of opposite sex and related wish to eliminate
parent of same sex. Boys feels that father will punish them for these sexual feelings

Symptoms of phallic fixation

Weak or confused sexual identity
Root cause of homosexuality

Afraid or incapable of close love or intimacy For males anxiety, guilty about sex Females sense of
inferiority and envy
 •The Oedipus complex in psychoanalytic theory is a
group of largely unconscious (dynamically repressed)
ideas and feelings which possess the parent of the
OEDIPUS opposite sex and eliminate the parent of the same sex
COMPLEX: •The complex is named after the Greek mythical
character Oedipus who (albeit unknowingly) kills his
father and marries his mother..

•Young girls develop an attraction towards their

father and sees mother as her main rival.
ELECTRA •The girl child also recognizes the morphological
COMPLEX difference between boys and girls, therefore, she
suffers from penis envy.

LATENCY(6 to 11yrs) GENITAL (11yrs onwards)

Extends through late childhood to puberty. Extends from 11 to 13 years to

young adulthood
Children may learn about social environment around
them, other people, culture values and their own skills and Sense of identity develops
capacity. Sexual motivation recede,preoccupied with
Reawakening of sexual urges.
developing skills & activities
Child has matured personality ,
not only focused on genitals,
also developing sexual
relationships.

Least complicated stage , children focus their energies on Satisfy genital potency and
their as well as forming friendship bonds with other realizes the goals for
children reproduction and survival.
 This stage also cause fixation ,
results in fetishes and
pedophiles.

If people experience difficulties

in this stage, its due to their
damage from earlier stages

MERITS OF FREUDS THEORY

 Earliest and most comprehensive theories of life long psychological development.

DEMERITS

 Extensive studies on adult psychological patient and hence its comparison to children is
not very justified

 Based on obsessed observation of psychologist.

 Pessimistic and deterministic approach to personality

 Over emphasis to infantile sexuality

APPLYING FREUD'S THEORIES TO CHILDREARING

 Recommend that parents encourage their children's natural tendencies to focus on the
above body parts and functions without allowing the children to overindulge.
 Parents should make every effort to educate themselves about what is considered
normal and healthy for their children and then balance the advice of child
development professionals with their own parental instincts and common sense.
  For most parents, raising happy, healthy children is a top priority and by staying
actively and directly involved in their children's lives, parents will be able to judge
the progress that their children are making along the way.

ERIKSON'S STAGES OF PSYCHOSOCIAL DEVELOPMENT-1963

 Erik Erikson was a psychologist who did most of his work in the post-Freudian era, in
the 1930s to the 1950s.
 He was a student of Freud, and was greatly influenced by the latter's theories of
personality development. However, unlike his predecessor, Erikson gave a great deal
of importance to the social environment in a person's psychological development
Erikson's stages of psychosocial development as articulated by Erik Erikson
explain eight stage through which a healthily developing human should pass from
infancy.
 Also known as theory of developmental tasks
 First 5 stages are extended from birth through adolescence.
 Stage 6 to 8 are young adult ,adult and late adult.

ORAL SENSORY STAGE: TRUST VS. MISTRUST (0 TO 12-18 MONTHS)

 Dependent on mother or mother substitute for his nutritional, emotional and

physiologic needs.
 Child-mother bond should develop to allow child to develop trust in the world

POSITIVE OUTCOME:

 If needs are met by parents, infants develop a secure attachment with parents but also
learn to trust their environment as well

NEGATIVE OUTCOME:

 If needs are not met infant will develop mistrust towards people, environment and
even towards themselves
 The first stage which corresponds to Freud's oral stage centers around the infant's
basic needs being met by the parents. The infant depends on the parents, especially
the mother, for food, and comfort.
  If the parents expose the child to warmth, regularity, and dependable affection, the
infant's view of the world will be one of trust.
 If the parents fail to provide a secure environment and to meet the child's basic
needs, a sense of mistrust will result.
 Basic fear of this stage is fear of abandonment.

DENTAL IMPLICATION

 Development of separation anxiety in child.

 Dental treatment if necessary should be done in presence of parents, preferably
parent holding the child.
 A child who never developed sense of basic trust is likely to be an extremely
frightened and uncooperative patient who needs special effort to establish rapport
and trust with dentist and staff

MUSCULAR ANAL STAGE: AUTONOMY VS SHAME, DOUBT (18 MONTHS TO 3

YEARS)

 Begin to push for independence, learn to walk ,talk and use toilets.

 The parents' recognize the young child capability and allow to develop at his own pace
,then a sense of self control of muscles and environment is developed.

 If parents are overprotective, child feels ashamed and doubts his abilities.

 Principle anxiety or fear of this period is fear of loss of love and fear of separation.

DENTAL IMPLICATION

 Parents presence is essential, at this stage the child takes pride in doing tasks by himself

 Dentist must obtain co-operation from him by making him believe that treatment is his
choice not of dentist or parent.

 Failure to develop a proper sense of autonomy results in doubt in the child’s mind about
his ability and in turn doubts others
LOCOMOTOR GENITAL STAGE : INITIATIVE VS. GUILT (3 TO 6yrs)

 Stage corresponds to phallic stage of Freud.

 Can initiate motor activities

 Activities like risk-taking behaviors, such as crossing a street on his or her own or riding
a bicycle alone.

 If parents are encouraging, children will learn to accept without guilt.

 If child is made to feel that certain activity is bad ,that the play is silly and stupid ,then
child may develop sense of guilt.

 The primary fear of this stage is fear of bodily injury

DENTAL IMPLICATION

 Child can be encouraged during dental visit

 Inherently teachable at this stage so can be taught about various things in dental set up.

 A child at this stage will be intensely curious about the dentist’s office and eager to learn
about the things found there

LATENCY: INDUSTRY VS. INFERIORITY (6 YEARS TO 12)

 At this stage, children are eager to learn and accomplish more complex skills: reading,
writing, telling time.

 They also get to form moral values, recognize cultural and individual differences.

 When children are encouraged and are praised and rewarded for results , a sense of
industry is enhanced

 If parents see the effort of children in making and doing things as ” mischief or
making a mess”, it will develop a sense of inferiority.
 DENTAL APPLICATION

 Child drive for industry and accomplishment, cooperation with treatment can be
obtained.

 Cooperation at this stage depends upon whether child understands what is needed to
please dentist and parents.

 Orthodontic treatment often begins during this stage of development.

 They can be motivated by improved acceptance or status from the peer group.

Adolescence stage: Identity vs. Role Confusion (12 to 20 years)

 Corresponds to genital stage of Freud

 Maturation is seen mentally as well as physiologically

 Plan for future

 Experience new ways of looking at and thinking about world.

 Capable of constructing theories and philosophies.

 Authority of parents is usually rejected in this stage for establishing own identity.

DENTAL IMPLICATION

 Behavior management of adolescents challenging.

 Orthodontic treatment should be carried out if child wants it and not parents as this stage
,parental authority is rejected.

INTIMACY VERSUS ISOLATION (LOVE)

 Succesful young adult ,for the first time ,can experience true intimacy-that makes
possible good marriage or a genuine and enduring friendship.

DENTAL IMPLICATION

 Young adults seek orthodontic treatment to correct their dental appearances and this is
characterized as internal motivation.
GENERATIVITY VERSUS STAGNATION(CARE)

In adulthood ,the psychosocial crisis demands generativity, both in sense of marriage and
parenthood, and in sense of working productively and creatively.

INTEGRITY VERSUS DESPAIR(WISDOM)

 If the other seven psychosocial crisis have been successfully resolved ,the mature adult
develop peak of adjustment : integrity.

 He trusts, independent and dares new has found well defined role in life.

MERITS OF ERIK ERIKSONS THEORY

 Based on age wise classification of individual

 Simple and comprehensive to understand

DEMERITS

 Based on extreme ends of personality.

Freud’s Psychosocial conflict Mode

AGE psychodynamic theory- Erik
theory Erikson

0-1 Oral stage Oral sensory stage Trust vs Hope

years mistrust

2-3 Anal stage Muscular Anal Autonomy vs Will

years stage shame

4-5 Phallic stage Locomotor genital Initiative vs Purpose

years stage guilt
6-12 Latency stage Latency stage Industry vs competence
years inferiority

13-18 Genital stage Adolescence stage Identity vs role Fidelity

years confusion

18- Intimacy vs love

40years isolation

30- Generativity vs care

60years stagnation

50 years Integrity vs wisdom

despair
THEORY OF COGNITIVE DEVELOPMENT [1952)

 The Theory of Cognitive Development, by Jean Piaget, proposes that there are four
distinct, increasingly sophisticated stages of mental representation that children pass
through on their way to an adult level of intelligence.

 Sensorimotor period (years 0 to 2)

 Preoperational period (years 2 to 7)

 Concrete operational period (years 7 to 12)

 Formal operational period (years 12 and up)

 Environment does not shape child behavior – child and adult actively seek to understand
environment.
 Cognitive refers to knowing and understanding ,it involves following key concepts.

 Schemas- Categories of knowledge that help us to interpret and understand the world.
According to Piaget schema includes both a category of knowledge and process of
obtaining that knowledge.
 Assimilation –process of taking new information into previously existing schemas.
 Accommodation-altering existing schemas or ideas as a result of new information.
 Equilibration- children try to balance between assimilation and accommodation.

SENSORIMOTOR PERIOD(0-2YEARS)

 "In this stage, infants construct an understanding of the world by coordinating sensory
experiences (such as looking, sucking, listening hearing) with physical, motoric actions.“

 Knowledge of the world is limited to sensory perception and motor activities.

 Stage of practical intelligence.

 Object Premanence, symbolic thoughts and Animism are hallmark of this stage.

PRE-OPERATIONAL STAGE(2-7)YRS

 Children can remember past events, engage in imaginary play.

 Child uses symbols in language and play.
 He learns to classify things
 Child is unaware of others perspective.
 Egocentrism, irreversibility, lack of conservation are hallmarks of this stage.

Dental Implication

Child surveys the dental chair, airway syringe.

 In the early stage, child’s world is egocentred or has the limited ability to share another
persons veiwpoint-Egocentrism

 His view of world is artificialistic and cannot distinguish what is real and what is not real-
Animism
 When a child is shown equal amount of water in two beakers and each one is poured into
two different glasses, one is short and wide ,the other is narrow and taller ,the
preoperational child thinks that taller glass contains more water.

 They are influenced by what they see- Lack of conservation.

 Irreversibility - which is inability to envision reversing an action.

CONCRETE OPERATIONAL PERIOD(7 YEAR -11YEARS)

 Thinking process becomes logical.

 Child is able to understand others point of veiw.

 Develops ability to use complex mental operations such as additions and substraction.

 Childs thinking is more stable and reasonable and he can understand relationships with
cause and effect.

Dental Implications

 Child has achieved the level of understanding and gets involved in treatment.eg-holds
suction tip by himself.

FORMAL OPERATIONAL PERIOD(11YRS-BEYOND)

 Child is a teenager now ,able to think abstractly.

 Imagine possibilities inherent in a problem.
 Skills such as logical thoughts, deductive reasoning and systemic planning also emerge
during this stage.
 The adolescents feel that they are constantly “in stage” being observed and criticized by
those around them. This phenomenon is called imaginary audience by David Elkind.
 The imaginary audience has powerful influence, making them self-conscious and
susceptible to peer influences.
 The notion that ‘others care about my appearance and feelings as much as I do” leads
adolescents to think that they are unique ,special individuals.
 As a result of this thought a second phenomenon emerges - personal fable is a powerful
motivator that allows us to cope in a dangerous world.
 Both this factors can also result in dysfunctional behavior .
THEORIES OF LEARNING AND DEVELOPING

BEHAVIOR

1) Social Learning Theory- Bandura(1963)

2) Classical conditioning- Pavlov(1927)

3) Operant Conditioning- Skinner(1938)

Other relevant theories

 Theory of Hierarchy of Needs-Maslow

 Margaret Mahlers theory of development.

SOCIAL LEARNING THEORY- BANDURA(1963)

 This theory is thought to be the most complete, clinically useful and theoretically
sophisticated form of behavior therapy.

 Acquisition of behavior through imitation of behavior of others(models) is observational

learning. It has 2 components acquisition and performance and is governed by 4
interrelated processes.
 a) Attention process

b) Retention process

c) Reproduction process

d) Motivational process

 In order to learn, you need to be paying attention

 The ability to store information is an important part of the learning process.(store a
mental representation )
 Once you have paid attention to the model and retained the information, it is time to
actually perform the behaviour you observed
 In order for observational learning to be successful, you have to be motivated to
imitate the behavior that has been modeled.

FACTORS AFFECTING OBSERVATIONAL LEARNING

 Acquisition versus performance- Bandura distinguishes between acquisition of a

learned response and performance of that response.

 Characteristic of role model- if they are liked and respected ,they are more likely
imitated.eg-cartoon character, sibling,parents,film stars etc

 Expected consequences of behavior- children observing other people getting rewarded

for positive behavior are likely to behave positively.

 Children observing older sibling defying and being punished are less likely to defy. This
is known as vicarious learning.

 Consequences of the model’s behavior affect the observers behavior vicariously.

 This is known as vicarious reinforcement. This is where in the model is reinforced for a
response and then the observer shows an increase in that same response.

 Catherine Do et al(2004) social learning theory is not only a preventive approach but
also easy and effective interventions that can be used with children ,with age 4-9 years
of age.
  Although studies have shown successful results with live modelling, this viable approach
is not widely used.

 It is identified that, problems with the technique is that vast majority of pediatric dentists
have not been formally trained in the usefulness and implementation of coping
techniques.

 Others consider live modeling a time-consuming and expensive procedure.

MERITS OF SOCIAL LEARNING

 Encompasses broader range of phenomena.

 Provides more explanatory concepts

DEMERITS

 Based only on observation of behavior of a person with overemphasis on the role of

environment.
Classical Conditioning - Ivan Pavlov(1927)

 Acquisition-learning a new response due to conditioning.

 Generalisation-stimuli similar to original conditioned stimulus, also evoke conditioned

response. Eg-a child with painful experience with doctor.

 Discrimination-learning to discriminate or respond to certain stimuli.eg-child exposed to

different clinic.

 Extinction-extinction of conditioned behavior results if association between conditioned

and unconditioned response is not reinforced. Eg-subsequent visit to doctor without
unpleasant experience result in extinction of fear.

 Spontaneous recovery-reappearance of an extinguished response after a period of non-

exposure
Treatment technique based on classical conditioning

 Counter conditioning-reducing a conditioned response(eg-anxiety) by establishing an

incompatible response (relaxation) to same conditioned stimuli.(injection)

Dental Implication

 Sound of hand piece and sight of dentist.

MERIT OF CLASSICAL CONDITIONING

 Simple to understand and applicable on child in clinic.

Stage 1: Before Conditioning:

 Unconditioned stimulus (UCS) produces an unconditioned response (UCR).

 For example, a stomach virus (UCS) would produce a response of nausea (UCR). A
perfume (UCS) could create a response of happiness or desire (UCR).

Stage 2: During Conditioning:

 During this stage a stimulus which produces no response (i.e., neutral) is associated with
the unconditioned stimulus at which point it now becomes known as the conditioned
stimulus (CS).

 For example, a stomach virus (UCS) might be associated with eating a certain food such
as chocolate (CS). Also, perfume (UCS) might be associated with a specific person (CS).

Stage 3 ; After Conditioning:

Now the conditioned stimulus (CS) has been associated with the unconditioned stimulus

(UCS) to create a new conditioned response (CR).

For example, a person (CS) who has been associated with nice perfume (UCS) is now found
attractive (CR). Also, chocolate (CS) which was eaten before a person was sick with a virus
(UCS) now produces a response of nausea.
OPERANT CONDITIONING – SKINNER (1938)

 It has been considered as an extension of classical conditioning

 Operant conditioning involves goal seeking actions and their consequences. Also called
as Instrumental conditioning

 Individual’s response is changed as a result of reinforcements or extinction of previous

responses, hence satisfactory outcome will be repeated and unsatisfactory outcome
diminish.

Extension of classical conditioning

 Law of the effect: means that a response will be strengthened or weakened,

depending on the positive or negative consequences that accompany it.
 Law of exercise: means that patterns are strengthened through repetition until this
pattern becomes a habit.
 Law of readiness: means that when an organism is ready for a particular activity, the
performance of that activity is satisfying whereas the Inhibition of it is annoying.
 Skinner (1948) studied operant conditioning by conducting experiments using
animals which he placed in a 'Skinner Box' which was similar to Thorndike’s puzzle
box.
Skinner described 4 basic types of operant conditioning distinguished with consequences

a) Positive reinforcement-occurs if pleasant consequence follows the response, a child is

rewarded for good behavior following dental treatment.

b) Negative reinforcement-withdrawal of unpleasant stimulus to increase probability of

behavior. Eg- if the parent gives in to the temper tantrums thrown by the child , he
reinforces this behaviour.

c) Omission-removal of pleasant response after particular response.eg-child misbehaves toy

is taken away , resulting in omission of undesirable behaviour.

d) Punishment-introduction of aversive stimulus into a situation to decrease the undesirable

behavior.eg-use of physical restraints, palatal rake for tongue thrust.

Positive Reinforcement

 Skinner showed how positive reinforcement worked by placing a hungry rat in his
Skinner box. The box contained a lever on the side, and as the rat moved about the box, it
would accidentally knock the lever. Immediately it did so a food pellet would drop into a
container next to the lever.

 The rats quickly learned to go straight to the lever after a few times of being put in the
box. The consequence of receiving food if they pressed the lever ensured that they would
repeat the action again and again.

Negative Reinforcement

 The removal of an unpleasant reinforcer can also strengthen behavior. This is known a
negative reinforcement because it is the removal of an adverse stimulus which is
‘rewarding’ to the animal or person. Negative reinforcement strengthens behavior
because it stops or removes an unpleasant experience.

 For example, if you do not complete your homework, you give your teacher £5. You will
complete your homework to avoid paying £5, thus strengthening the behavior of
completing your homework.
EXAMPLES OF OPERANT CONDITIONING

 Consider the case of children completing homework to earn a reward from a parent or
teacher, or employees finishing projects to receive praise or promotions.

 In these examples, the promise or possibility of rewards causes an increase in behavior,

but operant conditioning can also be used to decrease a behavior. The removal of an
undesirable outcome or the use of punishment can be used to decrease or prevent
undesirable behaviors.

 For example, a child may be told they will lose recess privileges if they talk out of turn
in class. This potential for punishment may lead to a decrease in disruptive behaviors.

Merits

 Applicable on children who are difficult to manage

 Usefull in instillation of life long positive behavior in a child patient

 Demerits

 Overemphasis on use of negative reinforces in dental clinic

 IN CLASSICAL CONDITIONING A STIMULUS LEADS TO A RESPONSE

 IN OPERANT CONDITIONING A RESPONSE BECOMES A FURTHER STIMULUS

NOTE :

 Positive and negative reinforcements are most suitable types of operant conditioning for
use in dental office

 Older children are just as susceptible to positive reinforcement as younger ones

 Techniques such as – voice control, HOME, some physical management technique –

known as AVERSIVE CONDITIONING – USED WITH CAUTION.

 Operant conditioning that occurs in one situation can be generalized to similar situations.
HIERARCHY OF NEEDS BY MASLOW(1954)

Abraham Maslow studied successful people rather than people with psychological problems.

 He found tat everyone wants to be happy and loving ,but they have specific needs
that must be met .
 Certain lower needs need to be satisfied before higher needs.
 Once a person has met their basic needs ,they can develop higher needs.
 He created a hierarchy of needs as a pyramid with 5 needs.

5 NEEDS

Physiological needs Food ,air, sleep ,clothing etc. Must be satisfied , If they are not
fulfilled, people direct all their energy and resource towards
satisfying them

Safety needs Both physical and psychological safeties ,protection, stability, pain
avoidance etc.Safety needs are psychological in nature ,which can
be security and safety at home and family

Love and belonging Social needs, that include affection, acceptance and inclusion. To
needs escape isolation and loneliness

Esteem needs Self respect and self esteem. Should be competent, to achieve ,to be
successful, independent

Self actualization A very small group of people reach this level, where all of their
needs (passion or needs are met
mission)
Dental Implication

Parental psychology and attitudes ,according to Maslow is based on hierachy and their
socioeconomical status might have influence on childs oral and dental health.

 The higher needs in this hierarchy only come into focus when the lower needs in the
pyramid are met. Once an individual has moved upwards to the next level, needs in the
lower level will no longer be prioritized.

MERITS

 Based on totality of personality development.

DEMERIT

 Theory is difficult and impractical to apply in children in dental situation as child has
ever changing personality
SEPERATION –INDIVIDUATION THEORY BY MARGRET S MAHLER(1933)

 Margaret Mahler assumed that the “psychological birth is not simultaneous to the
biological birth
 3 stages

Normal autistic phase(birth to 4 weeks)

 Infant is obvious to everything

 State of half asleep
 Achieve homeostatic equilibrium with environment

Normal symbiotic phase(4 weeks to 5 months)

 Recognize others not separate beings ,but as extension to him

 Social smile chacteristic(2 to 4 months)

Separation –individuation phase

 Consist of 4 sub phases ,that overlap over the next 5 to 36 months.

 Critical sub phase that psyche is shaped and lays foundation how the individual
interprets and responds
  first 3 years of life are critical in determining personality and mental health, The sub
phases are-

1.Differentiation(5 to 10 months) –

 Process of hatching from autistic shell ,developing alertness, sensorium that reflects
cognitive and emotional maturation
 "Rupture of the shell". Increased alertness and interest for the outside world. Using the
mother as a point of orientation
 Become alert as cognitive and neurological maturation occurs.
 comparing mother with the others-beginning of comparative scanning
 stranger anxiety which involves fear and curiosity(characteristic anxiety)

2.Practising(10-16 months)

 Marked by upright locomotion

 Learns to separate himself from mother by crawling

 Seperation anxiety present as child still requires mother for safety.

3)Rapprochement(16-24 months)

 Infant is toddler ,more aware of physical separateness

 Child tries overcome this by shows mother his newly acquired skills

 Mothers effort to help toddler not successful resulting in temper trantrums.

 Childs skill improve and able to get gratification from doing things himself.

4) Object constancy(24-36 months)-

 Child achieves a definite sense of individuality and is able to cope with mothers
absence.

 Does not feel uncomfortable on being separated from mother since he knows that she will
return.

 Develops improved sense of time and can tolerate delay.

 Merits of mahlers theory

 Can be applied to children

Demerit

 Not a very comprehensive theory.

CONCLUSION

 The collabration between psychology and dentistry offers both fields a better
understanding of dental anxiety and further improves the resources available to
those children that suffer with dental anxiety.
 To communicate successfully with a child, it is necessary to understand his/her
intellectual level and the way in which thought process work at the various
stages. Thus by knowing this a proper management and treatment can be done on
a pediatric patient.

REFERENCES

 David R.Shaffer, Child psychology; 8th edition; Cengage Learning Customer & Sales
Support, 1-800-354-9706,
 Shobha Tandon,textbook of Pedodontics ;2nd edition, PARAS medical publisher
 S.G Damle ,Text book of Pediatric dentistry;3rd edition
 Principles and application of learning theory in child patient management,Ziad D,
Baghdadi, DDS, PD, MS'(Quintessence int 2001:32:135-1410)
 The Journal of Contemporary Dental Practice, Volume 5, No. 1, February 15,
2004,catherine DO BS.
 Arpaci et al which maternal personality traits affect child behaviour during dental
treatment Eur J Paediatr Dent. 2016 Sep;17(3):239-242.
 Freeman R et al ; An anatomical commentary on the concept of infantile oral sadism;
Int J Ps. 1992 Psychoanal summer;73 ( Pt 2):343-8.
 Sharath Asokan, Sharmila Surendran, Sureetha Asokan, Sivakumar Nuvvula;
Relevance of Piaget's cognitive principles among 4-7 years old children: A
 descriptive cross-sectional study; Journal of Indian society of pedodontics and
preventive dentistry Year 2014 Volume : 32 Issue : 4 Page : 292-296.
 Delitala. G; Incorporating Piaget's theories into behavior management techniques for
the child dental patient, Gen Dent.2000 Jan-Feb;48(1):74-6.
 M Badakar C, J Thakkar P, M Hugar S, Kukreja P,, G Assudani H,, Gokhale N;
Evaluation of the Relevance of Piaget's Cognitive Principles among Parented and
Orphan Children in Belagavi City, Karnataka, India: A Comparative Study; Int J Clin
Pediatr Dent.2017 Oct-Dec;10(4):346-350. doi: 10.5005/jp-journals-10005-1463.
Epub 2017 Feb 27.