The psychology of child

THE PSYCHOLOGY OF CHILD

The developmental changes that occur from birth to adulthood were largely

ignored throughout much of history. Children were often viewed simply as small

versions of adults and little attention was paid to the many advances in cognitive

abilities, language usage, and physical growth .interest in the field of child

development began early in the 20th century and tended to focus on abnormal

behaviour.

Psychological development is dynamic process which begins at birth and

proceeds in an ascending order through a series of sequential stages manifesting

in various characteristic behaviors.

A study of the psychology of childhood if conscientiously and intelligently

pursued provides a rich background of information about children‘s behavior and

psychological growth under a variety of environmental conditions. It provides

information about psychological scales for appraising a child‘s developmental

status, provides certain norms of growth for comparative purpose, and provides

understanding of basic psychological processes like learning, motivation,

maturation and socialization. It gives general principles of development with

which to evaluate new trends and fads in child care and training and offers

practical suggestion for guiding the psychological growth of children and other

personal and natural components of their culture.

An understanding of the developmental tasks and behavior common to a certain

age group will equip the dentist with the knowledge of fear and needs of child at

that age. It will also enable him to detect any deviation in these patterns that may

interfere with the treatment process. Therefore, the knowledge of psychological

Behaviour guidance –non pharmacological management Page 62

 The psychology of child

growth and development is essential to view the child‘s development in terms of

psycho logic, social, cognitive and physical parameters.

Definitions

Psychology: Is the science dealing with human mature function and phenomenon

of his soul in the main.

Child psychology: Is the science that deals with the mental power or an

interaction through the conscious and subconscious element in a child.

Aims of child psychology

 Understand the child better and therefore deal with him more effectively

and efficiently.

 Better planning and interaction between treatment plan.

 To identify the problems of psychosomatic origin.

 To train the child so that he understand his own oral hygiene.


Helps modify child‘s developmental process.81

Importance of child psychology

 To know the problem of psychological origin

 To deliver dental services in a meaningful and effective manner

 To establish effective communication with the child and the parent

 To gain confidence of the child and of the parent

 To teach the child and parents importance of primary and preventive care

 To have a better treatment planning and interaction with other disciplines

 To produce a comfortable environment for the dental team to work on the

patient

Behaviour guidance –non pharmacological management Page 63

 The psychology of child

THEORIES OF CHILD PSYCHOLOGY

There are many theories that have been hypothesized over the centuries to

understand child development. However, no one theory is able to account for the

intricate matrix of psychology. But all these theories integrated together do throw

some light on the child‘s developmental status.

Child psychology theories can be broadly classified in these groups.

Theories of child psychology

According to learning pattern

Depending in stages

Non stage theories Theories of learning

Social learning theory Claasical condition

Stage theories Operant conditioning

Hierarchy of needs

psychoanalytic psychosocial Cognitive theory

Social learning theory

Classification of child psychology:

1. Psychodynamic theories:

Psychosexual theory/Psychoanalytic theory by

Sigmund Freud (1905)

Cognitive theory by Jean Piaget (1952)

Psychosocial theory/Model of personality

development by Erik Erikson (1963)

Behaviour guidance –non pharmacological management Page 64

 The psychology of child

2. Theories of learning and development of behavior:

Classical conditioning by Ivan Pavlov (1927)

Operant conditioning by BF Skinner (1938)

Hierarchy of needs by Abraham Maslow (1954)

Social learning theory by Albert Bandura (1963).

3. Margaret s Mahler’s theory of developMent

Perspective in psychology

There are various different approaches in contemporary psychology. An approach

is a perspective (i.e. view) that involves certain assumptions (i.e. beliefs) about

human behavior: the way they function, which aspects of them are worthy of

study and what research methods are appropriate for undertaking this study. Each

perspective has its strengths and weaknesses, and brings something different to

our understanding of human behavior. For this reasons, it is important that

psychology does have different perspectives to the understanding and study of

human behavior.

The biological perspective:

The study of physiology played a major role in the development of psychology as

a separate science, this perspective is known as biological psychology, this

perspective emphasizes the physical and biological bases of behavior. This

perspective has grown significantly over the last few decades, especially with

advances in our ability to explore and understand the human brain and nervous

system.

Behaviour guidance –non pharmacological management Page 65

 The psychology of child

The behavioral perspective:

Behavioral psychology is a perspective that focuses on learned behaviors. While

behaviorism dominated psychology early in the twentieth century, it began to lose

its hold during the 1950s. Today, the behavioral perspective is still concerned

with how behaviors are learned and reinforced.

The cognitive perspective:

During the 1960s, a new perspective known as cognitive psychology began to

take hold. This area of psychology focuses on mental processes such as memory,

thinking, problem solving, language and decision-making. Influenced by

psychologists such as Jean Piaget and Albert Bandura, this perspective has

grown tremendously in recent decades.

The cross-cultural perspective:

Cross-cultural psychology is a fairly new perspective that has grown significantly

in recent years. These psychologists and researchers look at human behavior

across different cultures. By looking at these differences, can learn more about

how culture influences thinking and behavior.

The evolutionary perspective:

Evolutionary psychology is focused on the study of how evolution explains

physiological processes. Psychologists and researchers take the basic principles of

evolution, including natural selection, and apply them to psychological

phenomena. This perspective suggests that these mental processes exist because

they serve an evolutionary purpose—they aid in survival and reproduction.

The humanistic perspective:

During the 1950s, a school of thought known as humanistic psychology emerged.

Influenced greatly by the work of prominent humanists such as Carl Rogers and

Behaviour guidance –non pharmacological management Page 66

 The psychology of child

Abraham Maslow, this perspective emphasizes the role of motivation on thought

and behavior. Concepts such as self-actualization are an essential part of this

perspective.

The psychodynamic perspective:

The psychodynamic perspective originated with the work of Sigmund Freud. This

perspective emphasizes the role of the unconscious mind, early childhood

experiences, and interpersonal relationships to explain human behavior and to

treat people suffering from mental illnesses.82

CLASSICAL PSYCHOANALYTICAL THEORY/PSYCHOSEXUAL THEORY •

This theory was given in 1905 by Sigmund Freud, an Australian physician and
father of modern day psychiatry.
He advocated the method of free association, which means the person, should say

everything that comes to his mind regardless of how trivial and embarrassing it

might be.

He said that a body has two types of neurons:

Phi neuron– concerned with condition of emotion and

Psi neuron– concerned with storage of emotion.

When the emotions reach a certain level a discharge is sparked off and this over

display of emotions is called archaic discharge.

He described human mind with the help of two model.

1 topographic model

Behaviour guidance –non pharmacological management Page 67

 The psychology of child

2 psychic model / psychic triad

TOPOGRAPHIC MODEL

Freud compared the human mind to an iceberg. The small part that shows above

the surface of the water represents the conscious experience and the much larger

base below water level represents the unconscious store house of impulses,

passions and inaccessible memories that affect thoughts and behaviors

FIGURE-3

Freud did not exactly invent the idea of the conscious versus unconscious mind,

but he certainly was responsible for making it popular.

The conscious mind is what you are aware of at any particular moment, your

present perceptions memories thoughts fantasies.

Working closely with the conscious mind is what Freud called the preconscious

mind or available memory; anything that can be easily made conscious like the

memories you are not at the moment thinking about but can readily bring to mind.

The largest, most complex and hidden is unconscious part. According to Freud,

unconscious is the source of our motivations whether they may be simple desires

of food or sex, neurotic compulsions or the motives of an artist or scientist and yet

Behaviour guidance –non pharmacological management Page 68

 The psychology of child

we are often driven to deny or resist becoming conscious of these motives and

they are often available to is only in disguised form.

Psychic Triad

Freud in 1923 made the tripartite structural model of ego, ID and superego and

hypothesized three structures in this theory to understand the intra psychic process

called the psychic triad .

FIGURE- 4

Freud‘s general notion that our behavior is influenced by biological drives (id),

social rules (superego), and mediating thought processes (ego) may not seem

farfetched.

ID:

It is the most primitive part of a personality. It is the basic structure of

personality, which serves as a reservoir of instincts. It is present at birth as

impulse and strives for immediate pleasure and gratification. Operating under the

guidance of primary process the ID lacks the capacity to modify the drive.

For example, need to eat in a young child is based on pleasure principle, i.e. the

child wants food irrespective of the external circumstances.

Behaviour guidance –non pharmacological management Page 69

 The psychology of child

Superego:

That part of personality that is internalized representation of the values and

morals of society as taught to the child by parents and others. It is essentially an

individual conscience and it judges whether the action is right or wrong.

Ego:

It is the part of self that is concerned with overall functioning and organization of

personality through its capacity to test reality and utilization of ego defence

mechanism and other functions like memory, language and creativity. Ego is

concerned with a state in which an adequate expression of ID can occur within the

constraints of reality and demands and restriction of superego.

For example, hunger must wait until food is given. The ego spans all three

topographic dimensions of conscious, preconscious, and unconscious. The ego is

the executive organ of the psyche and controls motility, perception, contact with

reality, and, through the mechanisms of defence available to it, the delay and

modulation of drive expression. Freud believed that ego substitutes the reality

principle for the pleasure principle.

FIGURE-5

Behaviour guidance –non pharmacological management Page 70

 The psychology of child

Psychosexual Stages of Development

According to Sigmund Freud what we do and why we do it, who we are and how

we become this way are all related to our sexual drive differences in personalities

originating in childhood. In the Freudian psychoanalytical model child personality

development is discussed in terms of psychosexual stages of development.

Freud outlined five stages of manifestations of the sexual development. At each

stage different areas dominate source of sexual arousal and differences in

satisfying the sexual urges at each stage will lead to differences in adult

personalities. A proper resolution of the conflicts will lead the child to progress

past one stage to another. Failure to achieve a proper resolution however, will

make the child fixated in the present stage and this is believed to be the cause of

many personality and behavioral disorders.83

1- Oral Stage

Age: 0 to 1.5 years.

Erogenous zone in focus: Mouth.

Gratifying activities: Nursing, eating, as well as mouth movement

including sucking, biting and swallowing.

Interaction with the environment: To the infant the mother‘s breast not

only is the source of food and drink but also represents her love. Because the

child‘s personality is controlled by the ID and therefore demands immediate

gratification, responsive nurturing is key (Both insufficient and forceful feeding

can result in fixation in this stage).

Behaviour guidance –non pharmacological management Page 71

 The psychology of child

FIGURE-6

Symptoms of oral fixation: Smoking, nail biting, drinking, sarcasm. 2-2 –

Anal Stage

Age: 1.5 to 3 years.

Erogenous zone in focus: Anus.

Gratifying activities : Bowel movement and the withholding of such

movement.

Interaction with the environment: The major event at this stage is toilet training, a

process through which children are taught when, where and how excretion is

deemed appropriate by society. Children at this stage start to notice the pleasure

and displeasure associated with bowel movements through toilet training. By

exercising control over the retention and expulsion of feces a child can choose to

either grant or refuse parent‘s wishes.

FIGURE -7

Behaviour guidance –non pharmacological management Page 72

 The psychology of child

Symptoms of Anal Fixation Anal–expulsive personality: If the parents

are too lenient and fail to instil the society‘s rules about bowel movement control,

the child will derive pleasure and success from the expulsion. Individuals with a

fixation on this mode of gratification are excessively sloppy, disorganized,

reckless, careless and defiant.

Anal–retentive personality: If a child receives excessive pressure and punishment

from parents during toilet training, he will experience anxiety during bowel

movements and hence will withhold such functions. Individuals with such

fixation are clean, orderly and intolerant to those who are not clean.

3- Urethral Stage

Age: 3 to 4 years.

Erogenous zones: This is a transitional stage between anal and phallic stages

and has characteristics of both.

Gratifying activities : Pleasure in urination.

Interaction with environment: The characteristics of the urethral stage

are often subsumed under those of the phallic stage. Urethral erotism, however, is

used to refer to the pleasure in urination; as well as the pleasure in urethral

retention analogous to anal retention. Similar issues of performance and control

are related to urethral functioning. Urethral functioning may also be invested with

a sadistic quality, often reflecting the persistence of anal sadistic urges. The

predominant urethral trait is that of competitiveness and ambition, probably

related to the compensation for shame due to loss of urethral control. Besides the

healthy effects analogous to those from the anal period urethral competence

provides a sense of pride and self-competence as a small boy can imitate and

match his father‘s adult performance.

Behaviour guidance –non pharmacological management Page 73

 The psychology of child

4 -Phallic Stage

Age: 4 to 5 years.

Erogenous zone in focus: Genitals.

Gratifying activities: Genital fondling.

Interaction with the environment:

FIGURE - 8

This is probably the most challenging stage in a person‘s psychosexual

development. The key event at this stage according to Freud is the child‘s feeling

of attraction towards the parent of the opposite sex together with envy and fear of

the same sex parent. In boys this situation is called the oedipus complex named

after the young man in a Greek myth who killed his father and married his mother

unaware of their true identities. Boys in the midst of oedipus complex often

experience intense ―castration anxiety‖, which come from the fear of punishment

from the father for their desire for the mothers. In the process of identifying with

Behaviour guidance –non pharmacological management Page 74

 The psychology of child

his father, the boy not only takes on his father‘s behavior patterns but also his

father‘s ideas of right and wrong. Thus, it is rough identification in the phallic

stage that the boy‘s superego begins to form.

In girls this type of attraction is called the Electra complex after Agamemnon‘s

daughter, who arranged for her mother to be murdered. For the girl, the sequence

begins with an erotic focus on the father. But, in addition, the girl notices that she

does not have the sexual organs of her father or brothers and she experiences

―penis envy.‖ She suspects that she may actually have been castrated by her

mother; this makes her angry, and she comes to resent and devalue her mother.

Nonetheless, she eventually identifies with her mother partly because she knows

if she takes on her mother‘s characteristics she will stand a better chance in her

own ―romantic relationship‖ with her father. Thus, in spite of her affection for her

father and her resentment of her mother, the little girl identifies with her mother,

behaving like her and incorporating her values.

Symptoms of Phallic Fixation

For men: Anxiety and guilty feelings about sex fear of castration and narcissistic

personality (interest in one‘s own features).

For women: It is implied that women never progress past this stage fully and

will always maintain a sense of envy and inferiority but there are no possible

fixations resulting from this stage

5 - Latency

Age: 5 years– Puberty.

Erogenous with in focus: None.

Behaviour guidance –non pharmacological management Page 75

 The psychology of child

Interaction with the environment: This is a period during which sexual

feelings are suppressed to allow children to focus their energy on other aspects of

life. This is a time of adjusting to the social environment outside of home,

absorbing the culture forming beliefs and values, developing same sex

friendships, engaging in sports, etc. Much of the child‘s energies are channelled

into developing new skills and acquiring new knowledge and play becomes

largely confined to other children of the same gender.

FIGURE - 9

6- Genital Stage

Age: Puberty onwards.

Erogenous zone in focus: Genital.

Gratifying activities : Heterosexual relationships.

Interaction with the environment: This stage is marked by a renewed

sexual interest and desire and the pursuit of relationships. There are three major

sources of sexual arousal during this period: memories and sensations from earlier

childhood periods, physical manipulation of genitals and other erogenous zones,

and hormonal secretions. Many of the themes and anxieties of earlier stages

resurface, but in new and more mature forms. In particular, the targets of sexual

Behaviour guidance –non pharmacological management Page 76

 The psychology of child

arousal now lie outside the tiny circle of self and family. Mature heterosexual

relations emerge, with the species preserving possibility of procreation now very

real.

FIGURE -11

Symptoms of genital fixation: This stage does not cause any fixation.

According to Freud if people experience difficulties at this stage the damage was

done in earlier oral, anal and phallic stages. These people come into this last stage

of development with fixations from earlier stages for example, attractions to the

opposite sex can be a source of anxiety at this stage if the person has not

successfully resolved the oedipus or electra conflict.

Avinash De Sousa in 2011 concluded that Whether psychoanalytic and cognitive

science views of the consciousness are fraternal or identical twins, do not know,

but they were certainly reared apart from one another. The psychoanalytic twin

was raised in the consulting room, exposed to primal scenes, intrapsychic conflict

and the risky improvisations of clinical work, whereas the cognitive twin was

raised in the scientific laboratory where calm and order prevailed. There is no

doubt that the cognitive and psychoanalytic views are different and come out of

different traditions (Shervin and Dickman, 1980). Cognitive science focusses on

motive, affect and conflict, whereas psychoanalysis focusses on conflict and

underlying psychological processes. There are in fact convergences between these

Behaviour guidance –non pharmacological management Page 77
 The psychology of child

two radically different views but from a holistic perspective. They follow a

similarity in the nature of the problems they address, though at first look they

seem to be far apart.

Sujita Kumar Kar, Ananya Choudhury in 2015 reported that Understanding

the sexuality development of adolescent is of utmost importance. Without this

understanding, one cannot move forward for clinical or educational intervention.

Understanding the factors influencing sexuality is also useful for intervention. At

the same time, understanding adolescent sexuality, will also help parents to

understand the difficulties of their children better and will help them to guide their

children in the crossroads of adolescence.81

PSYCHOSOCIAL THEORY/

THEORY OF DEVELOPMENTAL TASKS

The psychosocial theory was proposed by Erik Erikson in 1950 in his book

‗Childhood and Society‘. Erikson was a close friend and student of Freud and he

elaborated and modified Freud theory by superimposition of psychosocial and

psychosexual factors simultaneously contributing to personality development.

This theory postulates that society responds to a child‘s basic needs or

developmental tasks in a specific period of life and in doing so society ensures

child‘s healthy growth and survival in culture and traditions. According to

Erikson each individual passes through eight developmental stages. Each stage is

Behaviour guidance –non pharmacological management Page 78

 The psychology of child

characterized by a different psychological crisis, which must be resolved by the

individual before he can move on to the next stage .

FIGURE -11

If the person copes with a particular crisis in a maladaptive manner the outcome

will be more struggles with the same issue later in life.

Behaviour guidance –non pharmacological management Page 79

 The psychology of child

Erikson‘s stages
Stage Approximate age Positive outcomes Negative
outcomes
1. Trust vs Birth–1½ years Feelings of trust Fear and concern
Mistrust from environmental regarding others
support
2. Autonomy vs 1½-3 years Self-sufficiency if Doubts about
Shame-and doubt exploration is self, lack of
encouraged independence
3. Intative vs 3-6 years Discovery of ways Guilt from
Guilt to initiate actions actions and
thoughts
4. Industry vs 6-12 years Development of Feelings of
Inferiority sense of inferiority, no
competence sense of mastery
5. Identity vs Role Adolescence Awareness of Inability to
confusion uniqueness of self identify
appropriate roles
in life
6. Intimacy vs Early adulthood Development of Fear of
Isolation loving, sexual relationships with
relationships and others
same sex
friendships
7. Generativity vs Middle adulthood Sense of Trivialization of
Stagnation contribution to one‘s activities
continuity of life
8. Ego integrity vs Late adulthood Sense of unity in Regret over lost
Despair life‘s opportunities of
accomplishments life

TABLE -2

Behaviour guidance –non pharmacological management Page 80

 The psychology of child

Stage 1: Infancy – Age 0 to 1 year

Crisis: Trust vs Mistrust.

Description: In the first year of life infants depend on others for food, warmth

and affection and therefore must be able to blindly trust the parents (or caregivers)

for providing these.

Positive outcome: If their needs are met consistently and responsively by the

parents, infants not only will develop a secure attachment with the parents but

will learn to trust their environment in general as well.

Negative outcome: If no infant will develop mistrust towards people,

environment and even towards themselves.

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.

Stage 2: Toddler – Age 1 to 2 years

Crisis: Autonomy vs Doubt.

Description: Toddlers learn to walk, talk, use toilets and do thinks for

themselves. Their self-control and self-confidence begins to develop at this stage.

Positive outcome: If parents encourage their child‘s use of initiative and reassure

him when he makes mistakes, the child will develop the confidence needed to

cope with future situations that require choice, control and independence. The

parents should not discourage the child, but neither should they push. A balance is

required. People often advise new parents to be ―firm but tolerant‖ at this stage.

This way, the child will develop both self-control and self-esteem.

Behaviour guidance –non pharmacological management Page 81

 The psychology of child

Negative outcome: If parents are over protective or disapproving of the child‘s

acts of independence he may begin to feel ashamed of his behavior or have too

much doubt of his abilities. Another failure factor is unrestricted freedom, or if

you try to help children do what they should learn to do for themselves, you will

also give them the impression that they are not good for much. If you are not

patient enough to wait for your child to tie his or her shoe-laces, your child will

never learn to tie them, and will assume that this is too difficult to learn.

Dental application: Child is moving away from mother, but still will retreat to

her in threatening situations. So, parent‘s presence is essential in dental clinic. At

this stage as the child takes pleasure in doing tasks by himself; dentist must obtain

co-operation from him by making him believe that the treatment is his choice not

of the dentist/parent.

Stage 3: Early Childhood – Age 2 to 6 years

Crisis: Initiative vs Guilt.

Description: Children have newfound power at this stage as they have developed

motor skills and become more engaged in social interaction with people around

them. They now must learn to achieve a balance between eagerness for more

adventure and more responsibility and learning to control impulses and childish

fantasies.

Positive outcome: If parents are encouraging but consistent in discipline, children

will learn to accept without guilt that certain things are not allowed and at the

same time will not feel shame when using their imagination and engaging in make

believe role plays.

Negative outcome: If no children may develop a sense of guilt and may come to

believe that it is wrong to be independent.

Behaviour guidance –non pharmacological management Page 82

 The psychology of child

Dental application: For most children the first visit to dentist comes during the

stage of initiative. Going to the dentist can be considered a new and challenging

adventure in which the child can experience success. Success is coping with the

anxiety of visiting the dentist can help develop greater independence and produce

a sense of accomplishment. Poorly managed, of course, a dental visit can also

contribute toward the guilt that accompanies failure. A child at this stage will be

intensely curious about the dentist‘s office and eager to learn about the things out

there. An exploratory visit with little work is often a good way to start the dental

experience.

Stage 4: Elementary and Middle School Years – Age 6 to 12

Years

Crisis: Industry vs Inferiority.

Description: School is the important event at this stage. Children learn to make

things, use tools and acquire the skills to be a worker and a potential provider and

they do all these while making the transition from the world of home into the

world of peers. The child who, because of his successive and successful

resolutions of earlier psychosocial crisis, is trusting, autonomous, and full of

initiative will learn easily enough to be industrious. In Erikson‘s terms, the child

acquires industriousness and begins the preparation for entrance into a

competitive world. The influence of parents as role models decreases and the

influence of peer group increases.

Positive outcome: If children can discover pleasure in intellectual stimulation,

being productive, seeking success they will develop a sense of competence.

Behaviour guidance –non pharmacological management Page 83

 The psychology of child

Negative outcome: If the child is allowed too little success, because of harsh

teachers or rejecting peers, for example, then he or she will develop a sense of

inferiority or incompetence.

Dental application: Children at this age are trying to learn the skills and rules

that define success in any situation, and that includes the dental office. A key to

behavioral guidance is setting attainable intermediate goals, clearly outlining for

the child how to achieve those goals and positively reinforcing success in

achieving these goals. Because of the child‘s drive for a sense of industry and

accomplishment, cooperation with treatment can be obtained. Children at this

stage still are not likely to be motivated by abstract concepts rather they can be

motivated by improved acceptance or status from the peer group. This means that

emphasizing how the teeth will look better as the child cooperates is more likely

to be a motivating factor than emphasizing a better dental occlusion.

Stage 5: Adolescence – Age 12 to 18 Years

Crisis: Identity vs Role confusion.

Description: This is the time when we ask the question ‗Who am I‘? To

successfully answer this question Erikson suggests the adolescent must integrate

the healthy resolution of all earlier conflicts; adolescents who have successfully

dealt with earlier conflicts are ready for the identity crisis, which is considered by

Erikson as the single most significant conflict a person must face. Adolescence, a

period of intense physical development, is also the stage in psychosocial

development 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 is an extremely complex stage because of

the many new opportunities that arise. Emerging sexuality complicates

Behaviour guidance –non pharmacological management Page 84

 The psychology of child

relationships with others. At the same time physical ability changes and academic

responsibilities increase, and career possibilities begin to be defined. Members of

the peer group become important role models, and the values and tastes of parents

and other authority figures are likely to be rejected.

Positive outcome: If the adolescent solves this conflict successfully he will come

out of this age with a strong identity and ready to plan for the future.

Negative outcome: If not the adolescent will sink into confusion unable to make

decisions and choices especially about vocation, sexual orientation and his role in

life in general. As adolescence progresses, an inability to separate from the group

indicates some failure in identity development. This in turn can lead to a poor

sense of direction for the future, confusion regarding one‘s place in society, and

low self-esteem.

Dental application: Behavior management of adolescents can be challenging.

Any orthodontic treatment should be carried out if child wants it and not parents

as at this stage, parental authority is being rejected. Approval of peer group is

extremely important. For example, orthodontic treatment has become so common

that there may be a loss of status from being one of the few in the group who is

not receiving treatment, so that treatment may even be requested in order to

remain ―one of the crowd‖. It is extremely important to realize that treatment is

being done for him not to him. Abstract concepts can be grasped readily, but

appeals to do something because of its impact on personal health are not likely

not to be heeded.

Behaviour guidance –non pharmacological management Page 85

 The psychology of child

Stage 6: Young Adulthood – Age 19 to 40 Years

Crisis: Intimacy vs Isolation.

Description: In this stage, the most important events are love relationships. No

matter how successful you are with your work said Erikson you are not

developmentally complete until you are capable of intimacy. Successful

development of intimacy depends on a willingness to compromise and even to

sacrifice to maintain a relationship. An individual who has not developed a sense

of identity usually will fear a committed relationship and may retreat into

isolation.

Positive outcome: The adult individuals can form close relationships and share

with others if they have achieved a sense of identity. Success leads to the

establishment of affiliations and partnerships both with a mate and with others of

the same sex, in working toward the attainment of career goals.

Negative outcome: If not they will fear commitment, feel isolated and unable to

depend on anybody in the world. Failure leads to isolation from others and is

likely to be accompanied by strong prejudices and a set of attitudes that serve to

keep others away rather than bringing them into closer contact.

Dental application: At this stage, external appearances are very important as it

helps in attainment of intimate relation. Hence, the focus is orthodontic and

esthetic treatments.

Stage 7: Middle Adulthood – Age 40 to 65 Years

Crisis: Creativity vs Stagnation.

Description: By generativity Erikson refers to the adult‘s ability to look outside

oneself and care for others through parenting. The next generation is guided in

short not only by nurturing and influencing one‘s own children but also by

Behaviour guidance –non pharmacological management Page 86

 The psychology of child

supporting the network of social services needed to ensure the next generation‘s

success. The opposite personality trait in adults is stagnation, characterized by

self-indulgence and self-centred behavior.

Positive outcome: People can solve this crisis by having and nurturing children

or helping the next generation in other ways.

Negative outcome: Person will remain self-centred and experience stagnation

later in life.

Stage 8: Late Adulthood – Age 65 Years to Death

Crisis: Integrity vs Despair.

Description: Old age is a time for reflecting upon one‘s own life and seeing it

filled with pleasure and satisfaction or disappointments and failures.

Positive outcome: If the other seven psychosocial crises have been successfully

resolved, the mature adult develops the peak of adjustment: integrity. If the adult

has achieved a sense of fulfilment about life and a sense of unity within himself

and with others he will accept death with a sense of integrity just as healthy child

will not fear life.

Negative outcome: The opposite of this is despair. This is often expressed as

disgust and unhappiness on a broad scale, frequently accompanied by a fear that

death will occur before a life change that might lead to integrity can be

accomplished. 84

Behaviour guidance –non pharmacological management Page 87

 The psychology of child

THEORY OF COGNITIVE DEVELOPMENT

Jean Piaget world‘s leading theorist in the field of cognitive development

proposed this theory in 1952. His theory of cognitive development and

epistemological view are together called ―Genetic epistemology‖. This Piaget

defined as the study of acquisition, modification, and growth of abstract ideas on

the basis of inherited substrate an intelligent functioning that makes growth

possible. Piaget derived his theory by asking questions to children. He was less

interested if the answers given were correct, he was more concerned with the way

child arrived at the answer. Piaget proposed that a child‘s development proceeds

from an ego centric position through predictable expansion and incorporation of

learned experiences. It deals with cognitive development beginning with primitive

reflexes and motor co-ordination of infancy to thinking and problem solving of

adolescence till adulthood. He proposes that the world is a stable environment and

the child acquires this through the knowledge of mathematics and logic as reality.

Then as the child grows he is required to adapt according to people he is living

with.

These all stages can be grouped as following: –

Operation: An action, which the child performs mentally, and which has the

added property of being reversible.

Schema: Represent a dynamic process of differentiation and reorganization of

knowledge with the resultant evolution of behavior and cognitive functioning

Behaviour guidance –non pharmacological management Page 88

 The psychology of child

apparatus for the age of child. Schemas are categories of knowledge that help us

to interpret and understand the world. According to Piaget, schema includes both

a category of knowledge and the process of obtaining that knowledge. With

experience, the new information is used to modify, add to or change previously

existing schemas. For example, a child who has just learned the word ―bird‖ will

tend to assimilate all flying objects in to his idea of bird. When he sees a bee, he

will probably say, ―Look, bird!‖

Assimilation: New object or idea interpreted in terms of idea or action the child

has already acquired within his age specific skills. The process of taking in new

information in to previously existing schemas is known as assimilation. The

process is somewhat subjective, because we tend to modify experience or

information to fit in with our pre–existing beliefs.

Accommodation: Accommodation involves altering existing schemas, or ideas,

as a result of new information or new experiences. New schemas may also be

developed during this process. For example, the child who has just learned the

word bird will tend to assimilate all flying objects in his idea of bird. When he

sees a helicopter he will probably say ‗Look bird‘. However, for intelligence to

develop the child must also have the complementary process of accommodation.

Accommodation occurs when the child changes his or her cognitive structure or

mental category to better represent the environment, like to distinguish between

birds and helicopter. In other words the child will accommodate the events of

seeing a helicopter by creating a separate category of flying objects for helicopter.

Equilibrium: State established as a result of new knowledge to the child. Piaget

believed that children try to balance between assimilation and accommodation,

which is achieved through a mechanism called equilibration. As children progress

Behaviour guidance –non pharmacological management Page 89

 The psychology of child

through the stages of cognitive development, it is important to maintain a balance

between applying previous knowledge (assimilation) and changing behavior to

account for new knowledge (accommodation). Equilibration helps explain how

children are able to move from one stage of thought in to the next.

Piaget‘s marked four stages of cognitive growth each characterized by a different

type of thinking and in each child relies more upon internal stimuli.

1. Sensorimotor period (Birth to 2 years of age)

2. Preoperational period (2 to 7 Years of age)

• Preconceptual period (2 to 4 years of age)

• Intuitive stage (4 to 7 years of age)

3. Concrete operational period (7 to 11 years of age)

4. Formal operational period (Beyond 11years).

Sensorimotor Period

This is from birth to 2 years of age. During the first 2 years of life a child

develops from a new born infant who is almost totally dependent on reflex

activities to an individual who can develop new behavior.

During this stage child develops basic concept of object including the idea that

object in the environment are permanent and do not disappear when the child is

not looking at them.

Simple modes of thought that are the foundation of language develop during this

time but communication between a child and adult at this stage is extremely

limited because of the child‘s simple concepts and lack of language capabilities.

Animism is imparting life to inanimate objects, like furniture, wall, and floor or

doors, etc. And if the child gets hurt by those objects, the child will feel happy by

hitting them or if the caretaker or parents hit them.

Behaviour guidance –non pharmacological management Page 90

 The psychology of child

Dental application - the child begins to interact with the environment and can be

given toys while sitting on the dental chair in his/her hand.

This stage can be subdivided into six stages

Stage Age Schemata Co-ordinated reflexes

1st Birth to 2 months Automatic inborn reflexes of Uses inborn motor and
stage infants sensory reflexes (sucking,
grasping, looking) to interact
and accommodate to the
external world
2nd 2 to 5 months Coordination of reflexes Primary circular reaction—
stage improves coordinates activities of own
body and five senses (e.g.
sucking thumb); reality
remains subjective—does
not seek stimuli outside of
its visual field; displays
curiosity
3rd 5 to 9 months Infants try to perceive and Secondary circular
stage maintain interesting reaction—seeks out new
experiences stimuli in the environment;
starts both to anticipate
consequences of own
behavior and to act
purposefully to change the
environment; beginning of
intentional behaviour
4th 9 months to 1 year Coordinate sensorimotor Shows preliminary signs of
stage scheme object permanence; has a
vague concept that objects
exist apart from itself; plays
peekaboo; imitates novel
behaviors
5th 1 year to 18 months New sensorimotor schemes Tertiary circular reaction—
stage are invented seeks out new experiences;
produces novel behaviors
18 months to 2 years Invent new schemes through Symbolic though—uses

6th mental exploration in which symbolic representations of

stage they imagine certain events events and object; shows

and outcomes signs of reasoning e.g. uses
one toy to reach for and get
another, attains object
permanence

Behaviour guidance –non pharmacological management Page 91

 The psychology of child
TABLE -3

Preoperational Period

This is from 2 to 7 years of age and is called a transition period. Manipulation of

symbols or words is a characteristic feature of this stage. During this period

marked inconsistencies appear in the knowledge of a child.

Preoperational period can be divided in to two stages:

1. Preconceptual stage (2 to 4 years): – This stage marks the start of symbolic

activity. – The child‘s reactions are based not simply on the physical nature of the

stimulus but on its meaning. During this stage a stimulus begins to take on

meaning and the child can use a stimulus to represent other objects.

2. Intuitive stage (4 to 7 years): – Pre logical reasoning appears based on pre

conceptual appearances unhampered by reversibility. Trial and error may lead to

an intuitive discovery of correct relationships but the child is unable to take more

than one attribute into account at one time.

At preoperational period capabilities for logical reasoning are limited.

The child‘s thought process is dominated by the immediate sensory impressions.

At this stage, the child is first shown two equal size glass with water in them. The

child agrees that both contain the same amount of water. Then the contents of one

glass are poured into a taller, narrower glass while the child watches. Now when

asked which container has more water the child will usually say that tall one. His

impression is dominated by the greater height of the water in the tall glass .

Behaviour guidance –non pharmacological management Page 92

 The psychology of child

FIGURE - 12

Dental application: A preoperational child will have trouble in understanding a

chain of reasoning like brushing and flossing to remove food particles which in

turn prevents bacteria from forming acids which prevents tooth decay. But in this

stage he is much more likely to understand; brushing makes your teeth white,

clear and smooth.

The three main areas of focus in this stage are:

1. Constructivism: The child likes to explore things and make own observations.

For example, child surveys the dental chair, airway syringe.

2. Cognitive equilibrium: Child is explained about the equipment or instrument

and allowed to deal with it.

3. Animism: Child correlates things with other objects which they are more used

to or accustomed, For example, the handpiece can be called ―Whistling Willie‖

who is happy when he works at polishing the child‘s teeth.

Concrete Operational Period

This lasts from 7 to 11 years of age.

As the child moves into this stage typically after a year or so of preschool and

first grade activity, an improved ability to reason emerges. He can use a limited

number of logical processes especially those involving object that can be handled

or manipulated.

Behaviour guidance –non pharmacological management Page 93

 The psychology of child

The child is able to decentre, i.e. focus attention on more than one attribute at the

same time and also capable of rationale thinking so that he can classify objects

according to their sizes and shapes.

The child at this stage undergoes enormous surge in intellectual development and

is able to compare and tolerate different point of views. Syllogistic reasoning, in

which a logical conclusion is formed from two premises, appears during this

stage.

The principle of conservation and reversibility are also enhanced at this stage. At

this age the child could watch the water being poured from one glass to another

imagine the reverse of this process and conclude that the amount of water remains

the same.

Important processes during this stage are:

Seriation: The ability to sort objects in an order according to size, shape, or any

other characteristic. For example, if given different-shaded objects they may

make a color gradient.

Transitivity: The ability to recognize logical relationships among elements in a

serial order, and perform ‗transitive inferences‘ (for example, If A is taller than B,

and B is taller than C, then A must be taller than C).

Classification: The ability to name and identify sets of objects according to

appearance, size or other characteristic, including the idea that one set of objects

can include another.

Decentering: Where the child takes into account multiple aspects of a problem to

solve it.

Behaviour guidance –non pharmacological management Page 94

 The psychology of child

Reversibility: The child understands that numbers or objects can be changed,

then returned to their original state. For this reason, a child will be able to rapidly

determine that if 4+4 equals t, t−4 will equal 4, the original quantity.

Elimination of Egocentrism: The ability to view things from another‘s

perspective.

Dental application- include giving concrete instructions like this is a retainer,

brush like this, allowed to hold the mirror to see what is being done on his teeth,

gets involved in the treatment, e.g. holds the suction tip by himself.

Formal Operational Stage

This is after 11 years of age.

Ability to deal with abstract concept and abstract reasoning develops by about 11

to 12 years of age. This stage is more related to experiences than age and is

predictive of ability. In addition to the ability to deal with abstractions, teenagers

have developed cognitively to the point where they can think about thinking.

They are now aware that others think, but usually in a new expression of

egocentrism, presume that they and others are thinking about the same thing.

At this stage the child‘s thought process has become similar to that of an adult and

the child is capable of understanding concepts like health diseases and preventive

treatment.

The child can reason a hypothetical problem and do a systematic search for

solution.

Dental applications include aesthetic and corrective dental treatment.

García-Hoz V in 2003,studied The concept of conditioning as signalization

proposed by Ivan P. Pavlov (1927, 1928) in relation to the theory of stimulus-

substitution, which is also attributed to him. In the so-called theory of stimulus-

Behaviour guidance –non pharmacological management Page 95

 The psychology of child

substitution a distinction must be made between an empirical principle of

substitution and an actual theory of substitution, which can adopt different forms.

The Pavlovian theory of substitution--which conceives substitution as a

substitution of the unconditioned stimulus (US) by the conditioned stimulus (CS)

in the activation of the representation of the former--can be understood as an

explanation or model of signalization. Signalization and substitution are answers

to different questions, and the level of analysis to which signalization

corresponds, is that which concerns the nature of conditioning as an operation of

the animal in the environment.81

Stuart I. Hammond in 2014 ,examined children‘s early helping through the lens

of Piagetian moral and developmental theory, drawing on Piaget‘s ―Moral

Judgment of the Child‖ (Piaget, 1932/1997), ―Play, Dreams, and Imitation in

Childhood‖ (Piaget, 1945/1951), and the ―Grasp of Consciousness‖ (Piaget,

1976). Piaget refers to a level of moral development in action that precedes

heteronomous and autonomous moral reasoning. This action level allows children

to begin to interact with people and objects. In his later work, Piaget explores the

gradual construction of understanding from this activity level. Taken together,

these elements of Piagetian theory provide a promising conceptual framework for

understanding the development of early helping.85

Behaviour guidance –non pharmacological management Page 96

 The psychology of child

CLASSICAL CONDITIONING

This theory was first described by the Russian psychologist Ivan Pavlov in 1927.

He discovered during his studies of reflexes that apparently un associated stimuli

could produce the reflexive behavior. Pavlov classical experiment involved the

presentation of food to a hungry animal along with some of the other stimulus for

example, the ringing bell.

FIGURE - 13

In this famous experiment with dog he showed that the sight and smell of food

produced an unconditional response of salivation in the animal. He then presented

the food together with ringing bell. The sound of bell is called neutral stimulus

because it does not produce any response by itself. But the two events occurring

together also led to the unconditioned response of salivation and later the ringing

of the bell alone brought about conditional response of salivation

Behaviour guidance –non pharmacological management Page 97

 The psychology of child

FIGURE - 14

Classical conditioning thus operates by simple process of association of one

stimulus with other. For this reason this mode of learning is sometimes referred to

as learning by association. Principles of Classical Conditioning

Acquisition: Learning a new response from the environment by conditioning.

Generalization: Wherein the process of conditioning is evoked by a band of

stimuli centred around a specific conditioned stimulus.

For example, a child who had a painful experience with doctor in white coat will

always associate any doctor in white coat with pain.

Extinction: Removal of conditioned behavior results if the association between

the conditioned and the unconditioned response is not reinforced.

For example, in a fearful child subsequent visits to the doctor without any

unpleasant experience results in extinction of fear.

Discrimination: It is the opposite of generalization.

Behaviour guidance –non pharmacological management Page 98

 The psychology of child

For example, the conditioned association of white coats with pain can easily be

generalized to any office setting. If child is exposed to clinical setting which are

different to those associated with painful experiences, a dental office, for instance,

where painful injections are not necessary the child learns to discriminate between

two clinics and a generalized response to any office as a place where painful

things occur will be extinguished.

Dental Application

A young child is exposed to an initial stimulus like sound of the hand piece which

produces anxiety. This is an unconditioned reflex. When the sound of the hand

piece was coupled with dentist who was the neutral stimulus, it again produced an

unconditioned reflex of anxiety. Later when dentist was presented alone, it also

produced a conditioned response of anxiety.

FIRST VISIT CLASSIC CONDITIONING

WHITE COAT PAIN OF INJECTION

(UNCONDITIONED
(NEUTRAL STIMULUS)
STIMULUS)

PAIN OF INJECTION
(UNCONDITIONED FEAR AND CRYING
STIMULUS) (RESPONSE)

SECOND VISIT

SIGHT OF WHITE COAT PAIN OF INJECTION

(CONDITIONED (UNCONDITIONED
STIMULUS) STIMULUS)

PAIN OF INJECTION FEAR AND CRYING

(UNCONDITIONED
(RESPONSE)
STIMULUS)

Behaviour guidance –non pharmacological management Page 99

 The psychology of child

Classical conditioning occurs readily with young children and has considerable

impact on them on 1st dental visit. By the time a child is brought for the first visit

to a dentist it is highly likely that the child would have had many experiences with

other doctors. When child experiences pain, reflex reaction is crying and

withdrawal. In Pavlovian terms, the infliction of pain is unconditioned stimulus.

For instance, it is unusual for a child to encounter people.

Who are dressed entirely in white uniforms or long white coats. If the

unconditioned stimulus of painful treatment comes to be associated with the

conditioned stimulus of white coats, a child may cry and withdraw immediately at

the first sight of a white coated adult. Later the mere sight of the white coat is

enough to produce the reflex behavior initially associated with pain. If individual

in white coats are the ones who give painful injections that cause crying, the sight

of an individual in white coat soon may provoke an outburst of crying.86

Aguado L in 2003, reviewed Current knowledge on the neuronal substrates of

Pavlovian conditioning in animals and man is. First, work on conditioning in

aplysia, that has showed amplified pre-synaptic facilitation as the basic

mechanism of associative learning, is summarized. Then, two exemplars of

associative learning in vertebrates, fear conditioning in rodents and eyelid

conditioning in rabbits, are described and research into its neuronal substrates

discussed. Research showing the role of the amygdala in fear conditioning and of

the cerebellum in eyelid conditioning is reviewed, both at the circuit and cellular

plasticity levels. Special attention is given to the parallelism suggested by this

research between the neuronal mechanisms of conditioning and the principles of

formal learning theory. Finally, recent evidence showing a similar role of the

amygdala and of the cerebellum in human Pavlovian conditioning is discussed.

Behaviour guidance –non pharmacological management Page 100

 The psychology of child

OPERANT CONDITIONING

This was given by BF Skinner in 1938.

Operant conditioning can be viewed conceptually as a significant extension of

classical conditioning. Skinner contended that the most complex human behaviors

can be explained by operant conditioning. His theories, which downplay the role

of the individual‘s conscious determination in favor of unconscious determined

behavior, have met with much resistance but have been remarkably successful in

explaining many aspects of social behavior far too complicated to be understood

from the perspective of classical conditioning.

Skinner concluded that the most complex human behaviors could be explained by

operant conditioning. The basic principle of operant conditioning is that the

consequence of a behavior itself is a stimulus that can affect future behavior

response. Individual learns to produce a positive response where consequences of

outcome are instrumental in bringing about recurrence of stimulus. The individual

response is changed as a result of reinforcement of extension of previous

experiences.

Behavior that operates and controls the environment is called operant. It stresses

that reinforcement is critical factor for learning and therefore for development of

personality. The relationship between operant and consequences that follows

them is called contingency.

Behaviour guidance –non pharmacological management Page 101

 The psychology of child

Type of Operant Conditioning

FIGURE - 15

Positive reinforcement:

If a pleasant consequence follows a response, the response has been positively

reinforced and the behavior that led to this pleasant consequence become more

likely in the future.

For example, if a child is given a reward such as a toy for behaving well during

treatment, he is likely to behave well during future dental visits as his behavior

was positively reinforced.

Negative reinforcement:

It involves the withdrawal of an unpleasant stimulus after a response. Like

positive reinforcement negative reinforcement also increases the likelihood of a

response in the future.

For example, a child who visits to the dental clinic with an unpleasant

experience may throw a temper tantrum to go from clinic. If this behavior

(response) succeeds in allowing the child to escape, the behavior has been

negatively reinforced and is more likely to occur the next time.

Omission or time out:

Involves removal of a pleasant stimulus after a particular response.

Behaviour guidance –non pharmacological management Page 102

 The psychology of child

For example, if a child who throws a temper tantrum has his favorite toy taken

away for a short time as a consequence of this behavior, the probability of similar

misbehavior is decreased.

Punishment:

Where an unpleasant stimulus is presented after a response. This also decreases

the probability that the behavior that prompted punishment will occur in the

future. Punishment is effective at all ages. Result of adding negative outcomes or

removing positive ones thus weakening the response.

For example , use of palatal rake or tongue crib for correction of tongue thrusting

habit.

One milder form of punishment that can be used in children is the “voice

control”. It involves speaking to child in a firm voice to gain his/her attention,

telling him that his present behavior is unacceptable, and directing him as to how

he should behave.87

SOCIAL LEARNING THEORY

This theory was proposed by Albert Bandura in 1963.

In social learning theory reinforcement is considered a facilitative rather than a

necessary condition for learning.

Bandura believes that behavior is largely motivated by social needs.

Reinforcement is a powerful method for regulating performance of behavior but is

a relatively ineffective method for learning behavior.

The two most essential components of this theory are the concepts of modeling

and reinforcement.

Behaviour guidance –non pharmacological management Page 103

 The psychology of child

Principle of Social Learning Theory

ATTENTION EXTENT TO WHICH
WE FOCUS ON OTHER‘S
BEHAVIOUR

OBSERVATIONAL
RETENTION OUR ABILITY TO LEARNING ACQUISITION
RETAIN A REPRESENTATION OF
AND LATER
OTHER‘S BEHAVIOUR IN
MEMORY PERFORMANCE OF
BEHAVIOUR
DEMONSTRATED BY
PRODUCTION PROCESSES OUR
ABILITY TO ACTUALLY
OTHERS
PERFORM THE ACTIONS WE
OBSERVE

MOTIVATION OUR NEEDFOR

THE ACTIONS WE WITNESS,
THEIR USEFULNESS TO US

Attentional Process
A child cannot learn by observation if the child does not attend the essential

feature of the model‘s behavior. Simply exposing the child to the model does not

assure his attention.

Factors related to gaining his attention involve the relevancy of the model‘s

behavior to that of the observing child. This means that the observer must be able

to associate and identify with the model.

Observational learning can be an important tool in management of dental

treatment. If a young child observes an older sibling undergoing dental treatment

without complaint or uncooperative behavior, he or she is likely to imitate this

behavior. If the older sibling is observed being rewarded, the younger child will

also expect a reward for being well.

Retention Process

If the observer is to reproduce the model‘s behavior when the model is no longer

present to serve as a guide the response pattern must be memorized and coded in

Behaviour guidance –non pharmacological management Page 104

 The psychology of child

symbolic form.

Immediate imitation does not require much cognitive functioning, however

delayed imitation requires symbolic transformation and organization of the

modeling stimuli thus the learning requires cognitive development.

Motoric Reproduction

The amount of observational learning that a child can exhibit depends upon the

level of skills that the child has attained. These skills must be coordinated and

refined through self-corrective adjustment based upon performance feedback. •

Sitting in one dental chair watching the dentist work with someone else in an

adjacent chair can provide a great deal of observational learning about what the

experience will be like.

Reinforcement and Motivation

When positive incentives are provided, observational learning will be promptly

translated over performance. Therefore, the influence of modeling upon behavior

will be weakened as a result of failure to observe the relevant activities.88

HIERARCHY OF NEEDS

This was given in 1943 by Abraham Maslow in his paper A Theory of Human

Motivation.

This theory developed a classification of the individual priority needs and

motivations during personality development. A five level triangular hierarchy of

Behaviour guidance –non pharmacological management Page 105

 The psychology of child

these needs from the most basic and important to the most elaborate shows a trend

from instinctive motives to more rational intellectual ones.

Levels of Hierarchy of Needs

Level 1: Physiologic needs:

These are basic needs, such as food and water along with air, sleep, clothing, etc.

and must be satisfied before other needs. If they are not fulfilled, people will

direct all their energy and resources towards satisfying them. Biological

necessities such as food, water, oxygen, sleep, sex, etc. are the important needs

because a person would feel sickness, irritation, pain, discomfort, etc. or may

even die if they were not fulfilled.

Level 2: Safety needs:

Both physical and psychological safety is necessary to meet these needs. These

are protection, stability, pain avoidance, etc. Maslow believed that children need

safety more than adults when they feel afraid. Safety needs are mostly

psychological in nature which can be safety and security of a home and family.

Level 3: Love and belonging needs:

These needs are also termed as social needs that include affection, acceptance and

inclusion in integrated groups, the need for affection from parents, peers and other

loved ones. This is to give and receive love, and also for a feeling of belonging.

Level 4: Esteem needs:

This includes self-respect and self-esteem which are the needs to be respected; to

have self-respect, and to respect others. Humans include the need to be

competent, to achieve, to be successful, and to be open, and independent. In

addition esteem needs include the desire to be acknowledged and appreciated for

their achievements.

Behaviour guidance –non pharmacological management Page 106

 The psychology of child

Level 5: Self-actualization needs:

Maslow considered that a very small group of people reach a level called self-

actualization, where all of their needs are met. And it is described as a person

finding their ―passion or mission‖ .81

FIGURE - 16

These theories help in understanding how developmental changes occur in

the behaviour and understanding of a child. A thorough knowledge and
understanding of these theories helps in effective behaviour management of
a child in dental operatory.

Behaviour guidance –non pharmacological management Page 107