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Importance of child psychology
Theories of child psychology:
Psychoanalytical theory
Classical conditioning theory
Mahlers theory
Operant conditioning theory
Cognitive theory
Psychosocial theory
Social learning theory
Psychology is the science dealing with the human nature, function &
phenomenon of his soul in the main.
Psychological development is a dynamic process, which begin at the
birth and proceeds in a ascending order through a series of
sequential stages manifesting in the various characteristic behavior.
The aim is to understand the various aspect of child psychology,
applied to the dental situation for successful management of the child
in the dental clinic.
Psychology : It is the science dealing with human nature,
function and phenomenon of soul in the main.
Child psychology : It is the science or study of childs mind and
how it functions. It is also the science that deals with the
mental power or an interaction between the conscious and
subconscious elements in the child.
Emotion : An effective state of consciousness in which joy,
sorrow fear, hate or the likes are expressed.
A feeling or mood manifesting in motor and glandular activity.
Behaviour : It is any change observed in the functioning of the
Behaviour Management:
The means by which dental health team effectively and efficiently
performs treatment for a child and simultaneously instills appositive
dental attitude in the child.
It can also be considered as an attempt to alter the childs behaviour
and emotion in a beneficial manner according to the laws of society
To understand the child better.
To know the problem of psychology origin.
To deliver dental services in a meaningful and effective manner.
To gain confidence of the child and of the parent.
To have a better treatment planning and interaction with other
To produce a comfortable environment for the dental team to work on
the patient.
Childpsychologytheories canbebroadlyclassified
1. Psychodynamictheories:
Psychology theory/ Psychoanalytical theory sigmund
Freud (1905)
Psychosocial theory/ Model of personality development-
Erik Erikson (1963)
Cognitive theory Jean piaget(1952)
2. Theoriesof learninganddevelopmentof behaviour
Hierarchy of needs Maslow (1954)
Social learning theory by Bandura (1963)
Classical conditioning by Pavlov (1927)
Operant conditioning by Skinner (1938)
3. MargaretSMahlerstheoryof development
Sigmund Freud(1905) was the originator of
Psychoanalytical approach. Freuds interest in
development arose from his desire to explain the
disorder of personality in adults. He thought the
personality to originate from biological roots, as a result
of satisfaction of set of instincts of which sexual instinct
was the most important. He describe five psychosexual
stages. At each stages sexual energy is invested in a
particular part called an erogenous zone. He describe
human mind with the help of two models:
Topographic model
Psychic model/ psychic triad
According to this model human mind consist of
conscious, preconscious and subconscious mind.
The conscious mind is where we are paying attention at
the moment. It include only our current thinking and
Preconscious mind involve ordinary memory and
knowledge; things of which we are aware, but where we
are not paying attention at all moments but can
deliberately bring them into conscious mind by focusing.
Subconscious mind is where the process and content
are out of direct reach of conscious mind. It consist of that
part of our mind which thinks and acts independently.
Psychic structure proposed by freud in
psychodynamictheoryiscomposedof threeparts:
ID: It is the basic structure of personality, which serves as a
reservoir or their mental representative.It is present at birth ,
impulse ridden and gratification [ pleasure principle ].
EGO it develops out of id in the 2 and 6 month of life when the
infant begins to distinguish between itself and outside world; it
is the mediation between id and superego. Unlike id , ego is
governed by the reality principle. It is concerned with memory
and judgement. It is developed after birth, expand with age and
it delay, modifies and controls id impulses on a realistic
Super Ego: It is the prohibition learned from environment [ more
from parents and authorities ] . It acts as a censor of acceptability of
thoughts ,feeling and behavior . It is determined by regulations
imposed upon the child b parents , society ,and culture [ethics and
morals ] .It is the internalized control which produces feeling of
shame and guilt .
Ego defense mechanisms
The ego deals with the demands of reality, the id, and the super ego
as best as it can. But when the becomes overwhelming, the ego
must defend itself. It does o by unconsciously blocking the impulses
or distorting them into a more acceptable, less threatening form.
These techniques are known as the ego defense mechanisms.
This is the transfer of the desires or impulses onto a
substitute person or object. For example, if a student is
scolded by the teacher, he/she may take it out on a less
dangerous substitute, i.e., shouting at juniors, slamming a
door or stamping feet.
This is where characteristics or desires that are
acceptable to a persons ego are externalized or projected
onto someone else. A person having aggressive feelings
towards others may find it unacceptable to admit that he/she
has such feelings. Therefore these may be projected onto
others such as he/she may now feel that others have
aggressive feelings towards him or her.
Reaction formation
This is where a person displays behaviour that is exactly opposite
of an impulse that he/she dare not express or acknowledge, e.g.;
when you are not able to control your temper, you start laughing to
prevent anxiety or when you have bad experience of dental
treatment, to prevent anxiety you start thinking positive things about
the treatment.
An individual attempts to avoid current anxiety by withdrawing to
the behaviour patterns of an earlier age. It is the age-inappropriate
response. For example, a child with a history of nail biting may resort
to the same after growing uo as well, in times of danger, like he may
start biting nails if not prepared for the exam.
This can take two forms; the expulsion of thought and memories
that might provoke anxiety from the conscious mind (primary
repression) and the process by which hidden id impulses are
blocked from ever reaching consciousness (primal repression). It is
important to note that, within Freudian theory, repressed memories
are not deactivated; they continue to affect a persons behaviour
later in adulthood. However, this is mostly in disguised or symbolic
forms (such as dreams or neurotic behaviour), e.g.; if a child had a
painful dental experience in the past, in the future he/she may avoid
thinking about that painful event in order to repress anxiousness.
This is an attempt to explain our behaviour to ourselves and
others, in ways that are seen as rational and socially
acceptable, instead of irrational and unacceptable. It also
means to find logic in ones actions, e.g., after poor
performance in exam, student may try to rationalize the same
by blaming the teacher of doing strict marking.
This is where a person may deny some aspect of reality, e.g.,
a patient with big ulcer in the mouth diagnosed as carcinoma
may not be able to tackle the situation and he may consult
another doctor for denial of the diagnosis.
The expression of discomfort as a result of conflict
between the three components of the psychic structure
is defined as anxiety. Freud described six stages of
psychosexual development:
Oedipus complex
Young boys have a natural tendency to be attached to the
mother and they consider their father as their enemy. Hence
they strive to imitate their father to gain the affection of their
mother. Freud has also described Oedipus complex as a
desire to have a sexual relation with the mother. The name of
the Oedipus complex comes from Greek mythology. Oedipus,
the king of Thebe, unwittingly slew his father and married his
mother. The little boy adopts his fathers manners, his
attitudes and interests thinking that by becoming like his father
he can win his mothers sexual love.
Electra complex
Similarly, young girls develop an attraction towards their father and
they resent the mother being close to the father. Freud has reported
that little girls have a comparable Electra complex to resolve this. In
Greek mythology, Electra helped her brother slay the lover of their
father Agamemnon, in order to wins fathers love.
Merit of Freuds Theory
One of the earliest and the most comprehensive
theories of life long psychological development.
Demerits of Freuds Theory
Freud formulated this theory by his extensive studies on
adult psychological patients and hence its extrapolation
to children is not very justified.
This theory is based on obsessed observations of the
Russian psychologist, Ivan Petrovich Pavlov was one of the first to
study conditioned reflexes experimentally on dogs. In his
experiments, what it could be very significant about a dog salivation
when a tone was presented? The key is that the tone started as a
neutral stimulus. That is, it itself did not originally produce the
response of salivation. But Pavlov managed to convert that pairing
the tone with meat powder which was the unconditioned stimulus.
That is, it itself did not originally produce the response of salivation.
But Pavlov managed to convert that pairing the tone with meat
powder which was the unconditioned stimulus. That is, the natural
unlearned process did not have to be created through conditioning.
Through this process the tone acquired the capacity to trigger the
response of salivation. The dog learned to associate the tone with
food. Thus Pavlov demonstrated how learned associations were
formed by various events in an organisms environment.
The principles involved in the process
Acquisition Learning a new response from the environment by
Generalisationwherein the process of conditioning is evoked by a
band of stimuli centered around a specific conditioned stimulus. Thus
a test stimulus similar to training stimulus. Thus a test stimulus
similar to training stimulus results in response, e.g., a child who had
a painful experience with a doctor in a white coat always associates
any doctor in white coat with pain.
Extinctionof the conditioned behaviour results if the
association between the conditioned and the
unconditioned response is not reinforced,e.g., in the
above mentioned example subsequent visits to the
doctor without any unpleasant experiences results in
extinction of the fear.
Discrimination is the opposite of generalization. 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 and
even the generalized response to any office will be
The principle of classical conditioning can be used in
the following areas of animals and humans behaviour:
Developing good habits.
Breaking habits and elimination of conditioned fear.
Psychotherapy, to de-condition emotional fear.
Developing positive attitude.
Teaching alphabets.
Dental application: sound of handpiece and sight
of dentist
Merits of Classical Conditioning
Simple to understand and very applicable
on a child in dental clinic.
This theory categorizes the early childhood object
relations to understand personality development.
The period of childhood is thus divided into three
Normal autistic phase
Normal symbiotic phase
Seperation-individualization phase
Normal autistic phase (0-1yr)
It is a state of half-sleep, half-wakefullness.
This phase involves achievement of equilibrium with the environment.
Normal symbioticphase(3-4wkto4-5months)
The at this stage is lightly aware of the care taker but they both are
still undifferentiated.
Separation-individualisationProcess (5-36
This phase is divided into four sub phases
Differentiation (5-10 months)
Practicing period (10-16 months)
Rapprochement (16-24 months)
Consolidation and object constancy (24-36 months)
Merit of Mahlers Theory
Can be applied to children.
Demerit of Mahlers Theory
Not a very comprehensive theory.
According to this theory a child learn to produce response when the
consequence of it leads to the recurrence of the stimulus. Behaviour
that operates or controls the environment is called operant. It
stresses that reinforcement the critical factors for learning and
therefore for development of personality. The relation ship between
operant and consequences that follows them is called contingency.
Skinner described four basic types of operant
conditioning distinguished by the type of
Positive reinforcement occurs if a pleasant consequence
follows the response, e.g., a child rewarded for good behaviour
following dental treatment.
Negative reinforcement involves removal of unpleasant stimuli
following response , e.g., if the parent gives in to the temper tantrums
thrown by the child, he reinforces this behaviour.
Omission refers to removal of the pleasant response
after a particular response, e.g., if the child mis behaes
during the dental procedures, his favorite toy is taken
away for a short time resulting in the undesirable
Punishment involves introduction of an aversive
stimulus into a situation to decrease the undesirable
behaviour, e.g., use of palatal rake in correction of
tongue thrusting habit.
Positive and negative reinforcement are the most
suitable types of operant conditioning for a dental office,
while the other two types of operant conditioning should
be used wih caution. One mild form of punishment that
can be used for children is the voice control.
Applicable on children who are difficult to manage.
Useful in instillation of life-long positive behaviour in a
child dental patient.
Demeritof OperantConditioning
Overemphasis on use of negative reinforcers
punishment in dental clinic.
Paget formulate his theory on how children and
adolescents think and acquire knowledge. He derived
his theories from direct observation of children by
questioning them about their thinking. According to
piaget, the environment does not shape child
behaviour, but the child and adults actively seek to
understand the environment. This process of
adaptation is made up of three functional variants:
Assimilation concern with observing, recognizing,
taking up an object and relating it with earlier
Accomodation accounts for changing concepts and
strategies as a result of new assimilated
information. Piaget calls the strategies and mental
categories as schemas
Equilibration refers to changing basic assumptions
following adjustments in assimilated knowledge
so that the facts fit better.
The sequenceof development hasbeencategorizedinto four
major stages:
1. Sensorimotor stage(0-2 yr)
2. Pre-operational stage(2-6 yr)
3. Concrete operation stage(6-12 yr)
4. Formal operation stage(11-15 yr)
Merits of Piagets Theory
Most comprehensive theory of cognitive development.
This theory propagated that we can learn as much
about childrens intellectual development from
examining their incorrect answers to test items as from
examining their correct answers.
Underestimates childrens abilities.
Overestimates age differences in thinking.
Vagueness about the process of change.
Underestimates he role of the social environment.
Erikson differed from Freud who felt the "Child is
father of the man... While Freud felt the most
important years of personality development were
the first five, Erikson emphasized the ongoing
nature of personality development from birth
through death. Eriksons theory postulate that the
society responds to childs basic needs or
developmental tasks in each specific period of life
state that in doing so, society assure not only the
childs healthy growth but also the passage and
survival of societys own culture and traditions.
Erikson described 8 stages of life cycle
which are marked by internal crises
defined as a turning point. Each stage
demand resolution before the next stage
can be satisfactorily negotiated.
Stage 1:
Basic trust vs. mistrust (Birth to 12-18 months): infant must form a
first loving, trusting relationship with the caregiver or develop a
sense of mistrust
Dental applications
This stage identifies with development of separation anxiety in the
child. So if necessary to provide dental treatment at this early age, it
is preferable to do with the parent present and preferably with parent
holding the child.
Autonomy vs shame(18 months to 3 years): The childs
energies are directed toward the development of
physical skills, including walking, grasping, controlling
the sphincter. The child learn to control but may develop
shame and doubt if not handled well.
Dental application
Child is moving away from mother, but still retreat to her
in threatening situations. So parents presence is
essential in dental clinic. At this stages as the child
takes pleasures in doing tasks by himself; dentist must
obtain cooperation from him by making him believe that
the treatment is his choice not of the dentist.
Initiative vs Guilt(6 to 12 years): The child must deal
with demand to learn new skills or risk a sense of
inferiority, failure, or incompetence.
Dental application
child can be encouraged to view this visit as a new
adventure and encouraged to genuine success in it. If
this visit fail, it can lead to sense of guilt in child . He is
inherently teachable at this stage and so can be taught
about various things in detail set up. Independence has
to be reinforced rather than dependence.
Industry vs. inferiority(6 to 12 years): The child must
deal with demands to learn new skills or risk a sense of
inferiority, failure, or incompetence.
Dental Application
Child drive for sense of industry and accomplishment,
cooperation with treatment can be obtained. This needs
to be positively reinforced. Cooperation at this stage
depends on whether he/she understand what is needed
to please dentists/ parents.
Industry vs. Inferiority
Identity vs. role confusion(adolescence): the teenager
must achieve identity in occupation, gender roles,
politics, and religion.
Dental Application
Behavior management of adolescents can be
challenging. Any orthodontics treatment should be
carried out if child wants it and not parents as at this
stage, parental authority is being rejected.
Intimacy vs. Isolation: The young adult must develop
intimate relationship or suffer feeling or isolation.
Dental Application
At this stage, external appearance are very important as
it helps in attainment of intimate relation. These young
adults seek orthodontics treatment to correct their
dental appearance and this is characterized as internal
Intimacy versus Isolation
Generativity vs. stagnation(care): Each adults must find
some way to satisfy and support the next generation.
Integrity vs. Despair(wisdom):The culmination is a
sense of acceptance of oneself as one is and a sense
of fulfillment.
Meritsof ErikErikson
Based on age-wise classification of an individual, hence
easy to apply at any stage of development.
Simple and comprehensive to understand.
Demeritof ErikErikson
Based on the extreme ends of personality.
Social learning theory is thought to be the most
complete, clinically useful and theoretically a
sophisticated form of behaviour therapy.
The learning of behaviour is affected by four principal
1. Antecedent determinants- the conditioning is affected
if the person is aware of what is occurring.
2. Consequent determinants- Persons perception and
expectancy (cognitive factors) determine behaviour.
3. Modeling- Learning through observation eliminates the
trial- error search. It is not an automatic process
but requires cognitive factors and involves four processes
which are:
Attentional processes
Retention processes
Reproduction processes
Motivational processes
Self-regulation- this system involves a process of
self-regulation, judgement and evaluation of individuals
responses to his own behaviour.
Dental application
Children are capable of acquiring almost any behaviour
that they observe closely and are not too complex for
them to perform at the level of physical development.
Observational learning is an important tool in
management of dental treatment. If a young child
observes an older sibling undergoing dental treatment
without complaint/uncooperative behaviour, he/she is
likely to imitate this behaviour. Mothers attitude towards
dental treatment is likely to influence childs approach.
MeritsofSocial learningTheory
As compared to operant and classical conditioning, this
theory is:
Less reductionistic
Provides more explanatory concepts
Encompasses a broader range of phenomena
DemeritsofSocial LearningTheory
Based only on observation of behaviour of a person with
overemphasis on the role of the environment.