GOOD MORNING!

CHILD PSYCHOLOGY AND

BEHAVIOR MANAGEMENT
PRESENTED BY: DR. SHREYA
AGRAWAL (PART I PG)
 INTRODUCTION
• 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
1. Understand the child better and deal with
him more efficiently
2. Better planning and execution of treatment
plan
3. Identify the problems of psychomatic origin
4. Train the child to understand his own oral
hygiene
5. Helps modify child’s developmental process
 THEORIES OF CHILD PSYCHOLOGY
• Broadly classified in two groups:
1. Psychodynamic theories:
a. Psychosexual theory by Sigmund Freud (1905)
b. Cognitive theory by Jean Piaget (1952)
c. Psychosocial theory by Erik Erikson (1963)
2. Theories of learning and development of behaviour:
a. Classical conditioning by Ivan Pavlov (1927)
b. Operant conditioning by BF Skinner (1938)
c. Hierarchy of needs by Abraham Maslow (1954)
d. Social learning theory by Albert Bandura (1963)
 PSYCHOANALYTICAL / PSYCHOSEXUAL
THEORY
• Given by Sigmund Freud, an Australian
physician and Father of Modern-day
psychiatry.
• Advocated free association.
• Body as two types of neuron: (1) Phi neuron
(2) Psi neuron
• Freud compared the human
mind to an iceberg.
• ID: strives for immediate
pleasure and gratification
• SUPER-EGO: an individual
conscience and judges
whether the action is right
or wrong.
• EGO: a state in which
adequate expression of ID
can occur within demands
and restriction of super-
ego.
ROLE-PLAY OF ID, EGO AND SUPER-EGO
PSYCHOSEXUAL STAGES OF DEVELOPMENT

• Five stages of manifestations of the sexual

development:
1. Oral stage (0-1.5 years)
2. Anal stage (1.5-3 years)
3. Urethral stage (3-4 years)
4. Phallic stage (4-5 years)
5. Latency (5 years – puberty)
6. Genital stage ( puberty onwards)
 ORAL STAGE
• Erogenous zone – Mouth
• Gratifying activities – nursing, eating, sucking,
biting and swallowing.
• Babies experience world through their mouth.
• Symptoms of fixation – smoking, nail biting,
drinking, sarcasm.
 ANAL STAGE
• Erogenous zone – Anus
• Gratifying activities – Bowel movements and
withholding such movements
• Toddlers experience conflict over toilet training
• Symptoms of fixation –
1. Anal retentive personality – obsessive about
neatness and cleanliness
2. Anal expulsive personality – messy and
disorganized
 URETHRAL STAGE
• Erogenous zone – characteristics of both anal
and phallic stages
• Gratifying activities – pleasure in urination
• The predominant urethral trait is that of
competitiveness and ambition, probably
related to the compensation for shame due to
loss of urethral control.
 PHALLIC STAGE
• Erogenous zone – Genitals
• Gratifying activities – Self-stimulation of genitals
• Oedipus/Electra complex
• Boys >> “Castration Anxiety”
• Girls >> “Penis Envy”
• Symptoms of fixation –
1. For men : Anxiety and guilty feelings about sex, fear of
castration, and narcissistic personality.
2. For women : no possible fixations resulting from this
stage.
 LATENCY
• No erogenous focus.
• Sexual feelings are suppressed.
• Children focus their attention to learning and
developing new skills, absorb the culture,
beliefs and values outside of home
environment, develop same sex friendships.
 GENITAL STAGE
• Erogenous zone – Genitals
• Gratifying activities – Heterosexual
relationships
• Symptoms of fixation – does not cause any
fixation. Difficulties in this phase indicate that
damage was done in earlier stages.
 PSYCHOSOCIAL THEORY
• Erik Erikson proposed his theory in 1950 in his
book “Childhood and Society”.
• According to Erikson, the child’s healthy
growth and survival in culture and traditions
depends on the response of the society to the
child’s basic needs.
• An individual passes through eight
psychological stages, which must be
successfully resolved.
STAGES OF PSYCHOSOCIAL THEORY
 STAGE 1 : INFANCY

• Trust versus Mistrust

• Age : 0-1 years
• Infants depend on others for food, warmth and
affection.
• Needs met consistently >> secure attachment
with parents and trust general environment
• If not >> mistrust towards people and
environment.
• Separation anxiety.
 STAGE 2 : TODDLER
• Autonomy versus Doubt
• Age : 1 – 2 years
• Toddlers learn to walk, talk, use toilets, and do things
for themselves.
• The child will develop both self-control and self-esteem.
• He may begin to feel ashamed of his behavior or have
too much doubt of his abilities.
• Parent’s presence is essential in dental clinic. Dentist
must obtain cooperation from him by making him
believe that the treatment is his choice.
 STAGE 3 : EARLY CHILDHOOD
• Initiative versus Guilt.
• Age : 2-6 years
• Child develops motor skills and become engaged in
social interaction. Become curious and learn to
control impulses and childish fantasies.
• Initiative is shown by physical activity, extreme
curiosity & questioning
• Guilt results from goals that are initiated but not
completed.
• The first dental visit should be an exploratory visit
with little work.
 STAGE 4 : ELEMENTARY AND MIDDLE
SCHOOL YEARS
• Industry versus Inferiority
• Age : 6-12 years
• Child acquires industriousness & begins the
preparation for entrance into a competitive &
working world.
• Influence of peer group as role model increases.
• Failure to measure up to the peer group develops
sense of inferiority.
• Emphasizing how the teeth will look better as the
child cooperates is more likely to be a motivating
factor.
 STAGE 5 : ADOLESCENCE
• Identity v/s Role confusion
• Age : 12-18 years
• Identity crisis is considered by Erikson as the single
most significant conflict a person must face. A period
of intense physical development in which a unique
personality identity is acquired.
• Members of peer group become important role
models.
• Strong identity and ready to plan future.
• Confusion and inability to make decisions and choices.
• Treatment may be requested in order to remain “one
of the crowd”.
 STAGE 6 : YOUNG ADULTHOOD
• Intimacy v/s Isolation
• Age : 19-40 year
• Most important events are love relationships.
• A willingness to compromise and even to
sacrifice to maintain a relationship.
• Fear of commitment, feel isolated and unable to
depend on anyone.
• External appearances are important.. Focus is
orthodontic and esthetic treatment.
 STAGE 7 : MIDDLE ADULTHOOD
• Generativity v/s Stagnation
• Age : 40-65 years
• The adult’s ability to care for others and
support the network of social services.
• Stagnation implies self-indulgence and self-
centered behaviour.
 STAGE 8 : LATE ADULTHOOD
• Integrity v/s Despair
• Age : 65 years – death
• Reflecting upon one’s own life.
• Integrity implies a sense of fulfilment about
life.
• Despair is expressed as disgust and
unhappiness.
THEORY OF COGNITIVE DEVELOPMENT
• Jean Piaget gave this theory in 1952.
• According to him a child’s development
proceeds from a self-centered position
through learning and observing the
interactions with the environment.
• Adaptation occurs through two
complementary process: (1)Assimilation and
(2) Accommodation
 STAGES OF COGNITIVE GROWTH
1. Sensorimotor period (birth – 2 years)
2. Preoperational period (2-7 years)
3. Concrete operational period (7-11 years)
4. Formal operational period (beyond 11 years)
 SENSORIMOTOR PERIOD
• A child develops from a newborn infant who is
almost totally dependent on reflex activities to
an individual who can develop new behavior.
• Communication between child and adult is
extremely limited due to child’s lack of
language capabilities.
• Child can be given toys in his hand while
sitting on a dental chair.
 PREOPERATIONAL PERIOD
• Also called as transition period.
• Two sub stages :
1. Preconceptual stage (2-4 years): starts
symbolic activity. Stimulus begins to take
meaning.
2. Intuitive stage (4-7 years) : pre logical
reasoning.
 CONCRETE OPERATIONAL PERIOD
• Lasts from 7 to 11 years.
• Improved ability to reason.
• Can focus on more than one attribute at the
same time.
• Classify objects according to their sizes and
shapes.
 FORMAL OPERATIONAL STAGE
• After 11 years of age.
• Child is now aware that others think, but
usually in a new expression of egocentrism,
presume that they and others are thinking
about the same thing.
• Can reason a hypothetical problem and do a
systematic search for solution.
 CLASSICAL CONDITIONING
• Given by Ivan Pavlov in 1927.
 Every time they occur, the association between a
conditioned and unconditioned stimulus is strengthened.
 OPERANT CONDITIONING
• According to B.F Skinner – Operant conditioning is a
significant extension of classical conditioning.
• Consequence of behaviour is a stimulus for future
behaviour.
• Four basic types of operant conditioning:-
1. Positive reinforcement.
2. Negative reinforcement.
3. Omission or Time out.
4. Punishment
• 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.

• Negative reinforcement - It involves the

withdrawal of an unpleasant stimulus after a
response. Increases the likelihood of the
behaviour being repeated.
• Omission – removal of a pleasant stimulus
after a bad behaviour. Probability of a similar
behaviour is decreased.

• Punishment – where an unpleasant stimulus is

presented after a response. Result of adding
negative outcomes or removing positive ones
thus weakening the response.
 SOCIAL LEARNING THEORY
• Albert Bandura proposed this theory in 1963.
• According to him, the behavior is largely
motivated by social needs.
• Two most important components of this
theory are modeling and reinforcement.
 HEIRARCHY OF NEEDS
• Given by Abraham Maslow in 1943.
• This theory developed a classification of the
individual priority needs and motivations
during personality development.
LEVELS OF HEIRARCHY OF NEEDS
 BEHAVIOUR MANAGEMENT
• Behavior is any activity that can be observed,
recorded, and measured. It is an observable
act or any change in the functioning of an
organism.
• Behavior management is the means by which
the dental health team effectively and
efficiently performs treatment for a child and,
at the same time, instills a positive dental
attitude (Wright, 1975).
• Behavior modification is defined as the
attempt to alter human behavior and emotion
in a beneficial manner according to the laws of
modern learning theory (Eysenck, 1964).

• Behavior shaping is the procedure, which

slowly develops behavior by reinforcing a
successive approximation of the desired
behavior until the desired behavior comes into
being, for example, desensitization, tell–
show–do (TSD), modeling, distraction,
contingency management.
 CLASSIFICATION OF BEHAVIOR
MANAGEMENT TECHNIQUES
I. PSYCHOLOGICAL APPROACH:
1. Pre appointment behaviour management
2. Communication
3. Use of second language
4. Tell-show-do
5. Desensitization
6. Contingency management
7. Visual imagery
8. Behaviour shaping
9. Modelling
10. Assimilation and coping
11. Hypnosis
12. Retraining
13. Distraction
14. Externalization
15. Parental presence or absence
16. Reframing
17. Voice control
II. PHYSICAL APPROACH:
1. Hand over mouth
2. Physical restraints
III. PHARMACOLOGICAL:
3. Premedication
4. Conscious sedation
5. General anesthesia
 REFERENCES
1. TEXTBOOK OF PEDIATRIC DENTISTRY BY
NIKHIL MARWAH
2. TEXTBOOK OF PEDIATRIC DENTISTRY BY
SHOBHA TANDON
THANK YOU!