Concepts of Growth and Development

Done by:
Mahmoud A. Zoghbor Abeer Imad Mehjez
Hala M. Abu Hashem Rafeef F. Fayyad
Dima Bassam Hamad
Directed by:
Dr. Hazem Al-Ajrami
Dr. Ola B. Anan
❑ Reference:-
• Contemporary Orthodontics 6th Edition textbook
 Introduction:
• Psychological development is a dynamic process. Which
begins at birth and proceeds in an ascending order through a
series of sequential stages manifesting into various
characteristic behavior.

• These stages are governed by genetic, familial, cultural,

interpersonal and interpsychic factors.

• In this section, a brief overview of social, cognitive, and

behavioral development is presented, greatly simplifying a
complex subject and emphasizing the evaluation and
management of children who will be receiving dental and
orthodontic treatment.
Learning and the Development of Behavior
➢ The basic mechanisms of learning appear to be essentially the
same at all ages. As learning proceeds, more complex skills and
behaviors appear, but it is difficult to define the process in distinct
stages, a continuous flow model appears more appropriate.

➢ It is important to remember that this discussion is of the

development of behavioral patterns, not the acquisition of
knowledge or intellectual skills in the academic sense.

➢ At present, psychologists generally consider that there are three

distinct mechanisms by which behavioral responses are learned:
(1) Classical conditioning (2) Operant conditioning
(3)Observational learning
(1) Classical Conditioning
Classical conditioning was first described by the
Russian physiologist Ivan Pavlov, who discovered
in the 19th century during his studies of reflexes
that apparently unassociated stimuli could
produce reflexive behavior.
Pavlov’s classic experiments involved the presentation of
food to a hungry animal, along with some other stimulus,
for example, the ringing of a bell. The sight and sound of
food normally elicit salivation by a reflex mechanism.
If a bell is rung each time food is
presented, the auditory stimulus
of the ringing bell will become
associated with the food
presentation stimulus, and in a
relatively short time, the ringing of
a bell by itself will elicit salivation.
Classical conditioning occurs readily with young children and
has considerable impact on a young child's behavior on the
first visit to the dental office. By the time the child is brought
to the dental office he or she might have many experiences
with pediatricians and medical personnel when a child
experiences pain, the reflex reaction produced is crying and
withdrawal.
According to Pavlov the infliction of pain is
an unconditioned stimulus. If the
unconditioned stimulus white coats a child
may cry and withdraw immediately at the
first sight of white coated dentists.
• Association between a conditioned stimulus and
unconditioned stimulus strengthened or reinforced
every time they occur together.
• Every time they occur. The association between a
conditioned and an unconditioned stimulus is
strengthened
 (2) Operant Conditioning
• According to behavioural theorists B.F.Skinner this
operant conditioning is viewed conceptually as a
significant extension of classical conditioning.
• Operant conditioning differs from classical
conditioning in that the consequence of behaviour is
considered as a stimulus for future behaviour. This
means that the consequence of any particular
response will affect the probability of that response
occurring again in a similar situation.
• In classical conditioning, a stimulus leads to a response.

• In operant conditioning, a response becomes a further

stimulus.
❑ Types of operant conditioning
Skinner described four basic types of operant
conditioning, distinguished by the nature of the
consequence:
• Positive Reinforcement
• Negative Reinforcement
• Omission or Time out
• Punishment
 Positive Reinforcement
• If a pleasant consequence follows a response, the
response has been positively reinforced, and the
behaviour that lead to this Sant consequence becomes
more likely in the future.
Eg:- If a child is given a reward for such
as a toy for behaving well during his
first dental visit, he is more likely to
behave well during future dental
visits ,his behaviour was positively
reinforced.
 Negative Reinforcement
• Involves the withdrawal of an unpleasant stimulus
after a response.
Eg:- a child who views a visit to the dental clinic as an unpleasant
experience may throw a temper
tantrum at the prospect of having
to go there. If this behaviour
(response) succeeds in allowing the
child to escape the visit to the
clinic, the behaviour has been
negatively reinforced and is more
likely to occur the next time a visit
to the clinic is proposed.
 Omission or Time out

• Involves removal of a pleasant stimulus after

particular response.
E.g.:- If a child who throws a his
favorite toy taken away for a short
time as a consequence of this
behavior, probability of similar
misbehavior is decreased.
 Punishment
• This occurs when 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, not just with children.
• Simply praising a child for desirable behaviour produces positive
reinforcement and additional positive reinforcement can be
achieved by presenting some reward.
• Older children are just as susceptible to positive reinforcement
as younger ones.
• Adolescents in the orthodontic treatment age, for instance, can
obtain positive reinforcement from a simple pin saying “world’s
greatest orthodontic patient” or something similar.
• Omission and punishment, should be used sparingly
and with caution in the dental office. Because a
positive stimulus is removed in omission, the child
may react with anger or frustration.

• When punishment is used, both fear and anger

sometimes result.
 Voice Control
One mild form of punishment that can be used with
children is called "voice control" . Voice control involves
speaking to the child in a firm voice to gain his (or her)
attention, telling him that his present behavior is
unacceptable, and directing him as to how he (or she)
should behave.
• Operant conditioning that occurs in one situation can also be
generalized to similar situations. For example, a child who has
received positive reinforcement for good behavior in the
pediatrician's office is likely to behave well on the first visit to a
dentist's office because he or she will anticipate a reward at the
dentist's office also, based on the similarity of the situation.
• A child who continues to be
rewarded for good behavior in
the pediatrician's office but
does not receive similar rewards
in the dentist's office, however,
will learn to discriminate
between the two situations and
may eventually behave better
for the pediatrician than for the
dentist.
(1) Observational Learning (Modeling):
• Behavior is acquired is through imitation of behavior observed
in a social context.
• This technique used for the treatment of fears providing an
example or demonstration with the goal to let the child
reproduce behavior exhibited by the model. One of the parents
or another child undergoing dental treatment would be a good
example.
• The use of videotapes can also
be beneficial.
• This type of learning appears to be distinct from learning by either classical or
operan conditioning.
• Some theorists emphasize the importance of learning by imitation in a social
context, whereas others, especially Skinner and his followers, argue that
conditioning is more important, although recognizing that learning by imitation
can occur.

❑ There are two distinct stages in observational learning:-

• Acquisition of the behavior by observing it.

• The actual performance of that behavior.

A child can observe many behaviors and thereby acquire the potential to perform
them, without immediately demonstrating or performing that behavior.
Children are capable of acquiring almost any behavior that they observe closely
and that is not too complex for them to perform at their level of physical
development.
• Whether a child will actually perform an acquired behavior
depends on several factors:

1. The characteristics of the role model.

2. The expected consequences of the behavior.

• Observational learning can be an important tool in management of

dental treatment , that 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 bchaving
well.
• Because the parent is an important role model for a young child, the
mother's attitude toward dental treatment is likely to influence the child's
approach.
• *Research has demonstrated that one of the best predictors of how anxious a
child will be during dental treatment is how anxious the mother is.
• Observational learning can be used to advantage in the design of
treatment areas .

• At one time, it was routine for dentists to provide small private

cubicles in which all patients, children and adults, were treated.
The modern trend in orthodontics, particularly in treatment of
children and adolescents but to some extent with adults also, is an
open area with several treatment stations With someone else in an
adjacent chair can provide a great deal of observational learning
about what the experience will be like, Direct communication
among patients, answering questions about exactly what
happened, can add even further learning.
 Emotional Development
Erikson’s Erik theory of psychological
development
1. Development of Basic Trust (Birth to 18
Months)

trust
Can I trust
• if they can trust someone now, they can also trust others in
the future
the world ?
mistrust
• If they experience fear, they develop doubt and mistrust

So, the key of development in this stage is the mother

2- Development of Autonomy (18 Months
to 3 Years)
In this stage, they experience themselves and discover
their bodies.

Autonomy
If we are allowed to discover ourselves, then they Is it okay
develop self-confidence to be me ?
Shame and doubt
• if we are not, they can develop shame and self-
doubt

Now both parents play a major role .

3. Development of Initiative (3 to 6 Years).
In preschool, they take initiative, try out new things,
and learn basic principles like how round things roll
.
Initiative
Is it okay for
• If they are encouraged, they can follow their interests me to do
Guilt what I do ?
• If they are held back, they can develop guilt

They are now learning from the entire family.

 4. Mastery of Skills (7 to 11 Years).
At this stage, the child is working to acquire the academic and social skills that
will allow him or her to compete in an environment where significant
recognition is given to those who produce.

Industry Can I make it

• If they receive recognition from teachers or peers, they become in this
industrious
world?
Inferiority
• If they got too much negative feedback, they feel inferior and lose the
motivation

their neighbors and schools now influence them the most .

5. Development of Personal Identity
(12 to 17 Years).
Adolescence is also the stage in psychosocial
development in which a unique personal identity is
acquired.

Identity
• If their parents allow them to go out and explore, they can find an identity

Feeling lost
• If they push them to conform to their viewsm they can face role confusion and feel lost

The key to learning now is their peers and role models

6. Development of Intimacy (Young Adult).
They start to let go of the relationships they had
built earlier in order to fit in.

Intimacy
• If they can make a long-term commitment, they are confidence and happy

Isolation
• If they cannot form intimate relationships, they might end up feeling isolated and lonely

Friends and partners are now central to their

development
7. Guidance of the Next Generation
(Adult).

When they reach their forties they become comfortable, use

their leisure time creatively and maybe begin contributing to
society.
Generativity
• If they think that they are able to lead the next generation into this world, they are happy

Stagnation
• If they didn’t resolve some conflicts earlier, they can become pessimistic and experience
stagnation

People at home and work are now who influence them most.
8. Attainment of Integrity (Late Adult)
At this stage, the individual has adapted to the
combination of gratification and disappointment
that every adult experiences.

Ego integrity
• If they think they did well in their lives, they develop feeling of integrity .

despair
• If not , they can experience despair and become grumpy .

Time to compare themselves with mankind

 Cognitive Development (theory)
• Instructed by Jean Piaget in 1952.
• It focuses on development and thinking of child, rather
than learning.

• The goal of the theory is to explain the mechanisms and

processes by which the infant, and then the child,
develops into an individual who can
reason and think using hypotheses.
❑ There Are Three Basic Components To
Piaget's Cognitive Theory:

➢Schemas (building blocks of knowledge).

➢Adaptation processes (equilibrium, assimilation,

and accommodation).

➢Stages of Cognitive Development:

1. sensorimotor
2. preoperational
3. concrete operational
4. formal operational.
➢ Schemas

Schemas are the basic building blocks of such cognitive

models, and enable us to form a mental representation of the
world.

For example, a person might have a schema about buying a

meal in a restaurant. The schema is a stored form of the
pattern of behavior which includes looking at a menu,
ordering food, eating it and paying the bill. This is an
example of a type of schema called a 'script.' Whenever they
are in a restaurant, they retrieve this schema from memory
and apply it to the situation.
Piaget believed that newborn babies have a small number of
innate schemas - even before they have had many
opportunities to experience the world.
For example,

• Babies have a sucking reflex, which is triggered by

something touching the baby's lips. A baby will suck a
nipple, a comforter (dummy), or a person's finger.

• The grasping reflex which is elicited when something touches

the palm of a baby's hand.

• The rooting reflex, in which a baby will turn its head towards
something which touches its cheek.
➢ Adaptation processes

❑ Assimilation

Which is using an existing schema to deal with a new object

or situation.

❑Accommodation

This happens when the existing schema (knowledge) does

not work, and needs to be changed to deal with a new
object or situation.
For example, a child who has just learned the word “bird” will
tend to assimilate all flying objects into his idea of bird. When he
sees a bee, 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.
➢ Stages of Cognitive Development:

• Each child goes through the stages in the same order, and
child development is determined by biological maturation
and interaction with the environment.

• Although no stage can be missed out, there are individual

differences in the rate at which children progress through
stages, and some individuals may never attain the later
stages.
1. Sensorimotor babies up to 2 years old

The main achievement during this stage is object

permanence - knowing that an object still exists, even if it is
hidden.
2. Preoperational Stage (2 - 7 years)

During this stage, young children can think about things

symbolically. This is the ability to make one thing - a word or
an object - stand for something other than itself.

Thinking is still egocentric, and the infant has difficulty

taking the viewpoint of others.
▪ Egocentrism
Children’s thoughts and communications are typically
egocentric (i.e. about themselves). Egocentrism refers to
the child's inability to see a situation from another
person's point of view.

According to Piaget, the egocentric child assumes that

other people see, hear, and feel exactly the same as the
child does.
• Another characteristic of this stage is animism.

▪ Animism
This is the belief that inanimate objects (such as toys and
teddy bears) have human feelings and intentions
3. Concrete operational (7 - 11 years)

• Piaget considered the concrete stage a major turning point in

the child's cognitive development because it marks the
beginning of logical.

• This means the child can work things out internally in their
head (rather than physically try things out in the real world).

• Children can conserve number (age 6), mass (age 7), and
weight (age 9). Conservation is the understanding that
something stays the same in quantity even though its
appearance changes.
4. Period of Formal Operations (11 years and over)

• 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,
disease, and preventive treatment.

• At this stage, intellectually the child can and should

be treated as an adult.
CLINICAL CASE: -

13 years old girl patient came to your clinic with

her parents and her main complain is her
aesthetic appearance as she lost the two upper
centrals and laterals in an accident.

• What is/are the treatment plan/s in your

mind!
• Explain your plans with details…………
THANK
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