CHILD PSYCHOLOGY

1. CHILD PSYCHOLOGY
Presented by:
Khushbu Agrawal

2. CONTENT
• Introduction
• Theories of child psychology
• Classification of child’s behavior
• Factors affecting child’s behavior
• Behavior management
• Conclusion
• References
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3. Introduction
• What is Psychology ?
Science dealing with human nature, function and
phenomenon of his soul in the main
• What is Child Psychology ??
Science or study of child’s mind and how it functions
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Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008

4. Importance of Child Psychology:
• To better understand the child
• To know the problem of psychological origin
• To deliver dental sciences in a meaningful and effective manner
• To establish effective communication with the child
• To gain confidence of child and parents
• To teach child and parent importance of primary and preventive
care
• To have a better Rx planning and interaction
• To produce a comfortable environment for dental team to work
on the patient
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Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008

5. THEORIES OF CHILD PSYCHOLOGY
A] Psychodynamic theories
1.Psychosexual/Psychoanalytic
theory – Sigmund Freud (1905)
2.Cognitive theory – Jean Piaget (1952)
3.Psychosocial theory – Erik Erickson (1963)
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Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008

6. B] Theories of learning and behavior development
1. Classical conditioning – Pavlov (1927)
2. Operant conditioning – Skinner (1938)
3. Hierarchy of needs – Maslow (1954)
4. Social learning theory – Bandura (1963)
C] Margaret Mahler’s theory of development (1933)
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Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008

7. Psychoanalytic theory
• By Sigmund Freud in 1905
• Personality to originate from biological roots, as a
result of satisfaction of asset of instincts of
which sexual instinct being most important
• Categorized into 5 psychosexual stages
• At each stage sexual energy is invested in a
particular part called erogenous zone
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Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008

8. 2 models to
describe human
minds
Topographic
model
Psychic
model/triad
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Psychoanalytic theory…

9. a] Topographic model
• There are 3 levels of consciousness:
• Conscious - a part of personality which is aware of
thoughts and feelings for basic activities
• Preconscious - a part of personality of which the
individual is not aware of at the moment however able to
recollect into awareness without great difficulty.
• Subconscious/unconscious - part of personality of which
individual is unaware, which generally cannot bring into
awareness without help of assistant
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Psychoanalytic theory…

10. Mental iceberg concept by Sigmund Freud
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Psychoanalytic theory…

11. b] Psychic model/Psychic triad
Id
SuperegoEgo
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Psychoanalytic theory…

12. 1) ID
• Basic structure of personality, reservoir of instincts
• Based on pleasure principle
• Features of id
Present at birth
Impulse ridden (instinctual)
Strive for immediate pleasure and gratification
Selfish and cannot withstand pain
• If retained – aggressive personality
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Psychoanalytic theory…

13. 2) EGO
• Mediator between ID and Super ego
• Develops out of ID in the 2nd to 6th month of life
• Based on reality principle
• It modifies the ID and form the executive part of the
personality
• Concerned with memory and judgment
• Seat of consciousness
• It is the actual reality we experience
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Psychoanalytic theory…

14. 2) EGO
• Mediator between ID and Super ego
• Develops out of ID in the 2nd to 6th month of life
• Based on reality principle
• It modifies the ID and form the executive part of the
personality
• Concerned with memory and judgment
• Seat of consciousness.
• It is the actual reality we experience
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15. EGO DEFENCE MECHANISMS
• PROJECTION: Individual projects, personal feelings of
inadequacy onto someone in order to feel more
comfortable.
• DENIAL: Inability to accept the psychological impact of a
potentially stressful event .
• DISPLACEMENT: The transfer of hostile and aggressive
feelings from a original source to another, usually a less
important one.
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Psychoanalytic theory…

16. • IDENTIFICATION: assumption of qualities of some one
else to vent frustration or create fantasy (imitation)
• REACTION FORMATION: Transfer of hostile or more
aggressive impulses into their opposite or more socially
desirable form.
• RATIONALISATION: A strategy developed to excuse or
minimize the psychological consequences of an event.
• REPRESSION: The process of unconscious forgetting
which allows the suppression, painful experiences into
subconscious mind.
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17. 3) SUPEREGO
• Acts as a censor for acceptability of thoughts, feelings
and behavior
• It is determined by the restrictions imposed by the
parents, society and culture, i.e. morals and ethics
• It is developed by initial reward and punishment.
• Proper parenting is important.
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18. Freud’s stages of development
Oral stage
(0-1 year)
Anal stage
(2-3 year)
Phallic stage
(3-5 year)
Latency stage
(5-12 year)
Genital stage
(12-18 year)
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19. Stage 1: Oral stage (0-1 year)
• Perioral region is the area of pleasure and
gratification – erogenous zone
• Adequate and regular feeding is very important
• Dependent stage
• Satisfaction of this stage helps in the development
of trust and in later years it result in successful
achievements of needs
• If child’s needs are not met properly at this stage:
excessive optimism, pessimism, demandingness, envy,
jealousy
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20. Stage 2: Anal stage (2-3 year)
• Anal region - the zone of pleasure
• Ego centric or self centered behavior
• Maturation of his neuromuscular control
• Child become more independent and develops personal
autonomy.
• Over emphasis of toilet training causes compulsive,
obstinate, and perfectionist behavior in later life
• ANAL PERSONALITY: Characterized by disorderliness
abstinence, stubbornness, willfulness, frugality
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21. Stage 3: Phallic stage (3-5 year)
• Child becomes increasingly aware of his or her genitals,
he can differentiate the sexes.
• Characteristics:-
• Oedipus complex: boys become attached to his mother.
• Resolution of this crisis for boys is to identify with his
father and use him as a role model.
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22. • Electra complex :opposite of Oedipus complex. Girls get
attached to father
• Sense of shame and guilt
• Emergence of jealous and competitive feelings towards
peers and siblings
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Psychoanalytic theory…

23. Stage 4: Latency stage (5-12 year)
• Period of consolidation
• More importance is on peer development and character
formation
• Greater degree of control over instinctual impulses
• Lack of resolution of this stage can lead to immature
behavior and decreased development of skills
• Males tend to act as females and females tends to act as
males (tom boy)
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Psychoanalytic theory…

24. Stage 5: Genital stage (12-18 year)
• Spurt in sexual activity
• Hormonal and physiological changes increase the interest
in sexual matters
• Sense of identity develops
• Personality matures
• Helps to separate from dependence of parents
• Their acceptance of adult role, functions with social
expectations and cultural values
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25. • Most important stage that shapes the future of a child
are oral and phallic stages
• A successful resolution of oral stages give the
foundation of close trusting relationship while
unresolved phallic stage leads to confusion over sexual
role and behavior
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Psychoanalytic theory…

26. • By Jean Piaget in 1952
• Survival of the fittest and the most adaptable is
the driving force for development.
• Cognitive development is the interaction between
the individual and the environment
cognitive theory
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Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008

27. • Two types of cognitive structure
• Simple mental structure present at
birth
• Internal representation of some
specific action or behavior
Schemas
• Develop later in cognitive development
• More complex
• Represent internal structures of a
high order that have the distinctive
features of being reversible
Operations
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Cognitive theory…

28. ADAPTATION OF COGNITIVE STRUCTURE
• By two process
• Assimilation: Refers to incorporation of new objects,
thoughts, and behavior into existing structures.
• Accommodation: Is the change of existing structures in
response to novel experiences
• Equilibration : Is the means by which the individual
balances the competing forces of assimilation and
accommodation.
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Cognitive theory…
Contemporary orthodontics by William Profitt 5th Edi. 2008

29. PIAGETS STAGES OF COGNITIVE
DEVELOPMENT
Sensorimotor period (birth to 2 years)
Preoperational period (2-7 years)
Concrete operational (7-12 years)
Formal operational period (>12 years)
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Cognitive theory…
Contemporary orthodontics by William Profitt 5th Edi. 2008

30. 32
Cognitive theory…

31. A] Sensorimotor stage (birth to 2yrs)
• Child born with certain basic characters for interacting
with the environment.
• This primitive strategies mark the beginning of the
thinking process.
• Child does not yet have the capacity to represent
object (or) people to himself mentally.
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Cognitive theory…

32. • As maturation progresses the simple reflexes begin to
be coordinated.
• E.g. arm is moved, eyes keep on watching it
• By l0th month, variety of elementary schemes develop.
• Permanent relating of object develops in course of
coordinating actions with repeated contacts with
environment
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Cognitive theory…

33. Dental application:
• Child begins to interact with the environment and can
be given toys while sitting on a dental chair in his hand
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34. B] Preoperational stage (2 to 6yrs)
• Primitive strategies changes as the child assimilates
new experiences and accommodates original strategies.
• The child uses symbols in language with play.
• Learns to classify things.
• Solves problems as a result of intuitive thinking but
cannot explain why
• Concept of egocentrism
• Unaware of others perspective
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Cognitive theory…

35. Egocentrism – unable to look from others perspective
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Cognitive theory…

36. Immediate sensory impressions
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Cognitive theory…

37. Dental application:
• Constructivism
• Cognitive equilibrium
• Animism
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Cognitive theory…

38. C] Concrete operation stage (6 to 12yrs)
• The thinking process becomes logical
• Ability to use complex mental operations such as
addition and subtraction.
• Child is able to understand others point of view.
• Development based on the level of understanding
achieved so far
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Cognitive theory…

39. 41
Cognitive theory…
Changing the appearance or arrangement of objects does
not change their key properties

40. Dental application:
• Concrete instructions like this is a retainer,
brush like this
• Abstract instructions like wear the retainer
every night and keep clean
• Centering – allowed to hold the mirror to see
what is being done on his teeth
• Egocentrism – achieved level of understanding
and gets involved in the treatment
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Cognitive theory…

41. D] Formal operation stage (11 to 15yrs)
• Development of reasoning capacity
• Child able to think more abstractly
• Can imagine possibilities inherent in a problem
• Uses inductive (or) deductive logic to make decisions to
solve problems
• Thinks of ideas and has developed a vast imagination
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Cognitive theory…

42. Dental application:
• Peer influence and abstract thinking increases
• Play important role in orthodontic appliances
and braces
• Imaginary audience (by Elkind)
• Personal fable
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Cognitive theory…
Contemporary orthodontics by William Profitt 5th Edi. 2008

43. 45
Cognitive theory…

44. MERITS AND DEMERITS
• Research works have failed to demonstrate the
existence of cognitive structures.
• Children are consistently inconsistent in their approach
to problem solving despite using the same cognitive
structures.
• Lately it has been suggested that this inadequacy in
problem solving are related to memory power of the
child rather than cognitive ability.
• Piaget was better at describing processes than
explaining how they operate.
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Cognitive theory…

45. • By Ivan Pavlov in 1927
• Based on stimulus reflex response (an involuntary
response to an external stimuli)
• When two events ,observed to occur together (proximity
in time and space),will tend to be associated or paired
together by the observer(pairing of initial and neutral
stimuli).
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CLASSICAL CONDITIONING

46. Generalization
• Process of conditioning is evoked by a band of stimuli
centered around a specific conditioned stimulus. Thus a
test stimulus similar to training stimulus results in
response.
Extinction
• If reinforcement does not occur results in extinction of
the fear.
Discrimination
• It is opposite of generalization. If the child is exposed
to clinical setting which are different, child learns to
discriminate between the two clinics and even the
generalized response to any office will extinguish.
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47. 49

48. 50

49. • Skinner in 1938
• The consequence of behavior itself acts as a stimulus
and affect future behavior
• Operant: behavior that operates or controls the
environment
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OPERANT CONDITIONING

50. 1. Positive reinforcement
• Occurs if a pleasant consequence follows the
response e.g., a child rewarded for good behavior
following dental treatment.
2. Negative reinforcement
• Involves removal of unpleasant stimulus following a
response, e.g., if the parent gives into the temper
tantrums thrown by the child, he reinforces this
behavior.
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51. 3. Omission
• Refer to removal of the pleasant response after a
particular response e.g., if the child misbehaves during
dental procedure. If it’s favorite toy is taken away for
short time resulting in the omission of the undesirable
behavior.
4. Punishment
• Involves introduction of an aversive stimulus into a
situation to decrease the undesirable behavior, e.g.,
use of parental rake in correction of tongue thrusting
habit.
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52. 54

53. Benjamin theory (1960)
• He says, “Thumb sucking arises from the rooting (or)
placing reflex seen in all mammalian infants. Rooting
reflex is the movement of the infant’s head and tongue
towards an object touching his cheek.
• The object is usually the mother’s breast but may also
be a finger (or) a pacifier.
• This rooting reflex disappears in normal infants around
7-8 months
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54. Dunlop Beta hypothesis
• He states that best way to break a habit is by its
conscious, purposeful repetition. He suggests that the
child should be asked to suck his thumb observing
himself as he indulges in the habit.
• This procedure is very effective if the child is asked to
do the same at a time when he is involved in an enjoyable
activity.
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55. Classification of child’s behavior
A] Wilson (1933)
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WILSON
(1933)
Normal or
bold
Tasteful or
timid
Hysterical
or
rebellious
Nervous or
child

56. B] Frankel’s behavior rating scale
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FRANKEL
(1962)
Definitely
negative
(--)
Negative
(-)
Positive
(+)
Definitely
positive
(++)

57. C] Wright (1975)
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COOPERATIVE
a) Cooperative behavior
b) Lacking cooperative
ability
c) Potentially cooperative
UNCOOPERATIVE
a) Uncontrolled/ hysterical
b) Defiant/ Obstinate
c) Tense cooperative
d) Timid
e) Whining type
f) Stoic

58. Factors affecting child’s behavior
A] Under control of the dentist
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Effect of dental office environment
Effect od dentist’s attitude and activity
Dentist’s attire
Presence/absence of parents in the operatory
Presence of older sibling

59. B] Out of control of the dentist
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Growth and development
Nutritional factors
Past dental experiences
Genetics
School environment
Socioeconomic status

60. C] Under the control of the parents
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Home environment
Family development and peer influence
Maternal behavior

61. behavior management
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62. 64
• Behavior management (Wright 1975)
Means by which the dental health team effectively and
efficiently performs dental treatment and thereby instills
a positive dental attitude
• Behavior shaping
Procedure which slowly develops behavior by reinforcing a
successive approximation of the desired until the desired
behavior comes into being

63. 65
Classification of
behavior management
Non-pharmacological
Communicati
on
Behavior
shaping
Behavior
management
Pharmacological
Premedication Conscious
sedation
General
anesthesia

64. Communicative Management
• Used in both cooperative and uncooperative child
(Chambers in 1976)
• Basis for establishing a relationship with the child
• The communication should always be established from
the first entry i.e. to the reception area

65. • Types of communication:
1. Verbal
2. Nonverbal
• Body language
• Smiling
• Eye contact
• Expression of feeling
• Showing concern
• By touching the child
• Giving him a pat
• Giving a hug
3. Using both
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66. Behavior shaping
1] Desensitization
• Joseph Wolpe (1975)
• It is accompanied by teaching the child a competing
response such as relaxing and then introducing a
threatening stimuli
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67. Tell Do Show (TDS)
• Addleston in 1959
• Continuously and in grades the procedure should be
moved from the least fear promoting object to more
fearful ones.
• Indication for TSD:
• 1st visit.
• Subsequent visits when introducing new procedure
• Fearful child.
• Apprehensive child because of information received by
peers or parents
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68. 2] Modeling
• Bandura in 1969
• Social learning principle
• Modelling can be done by
• Live models – siblings, parents of child etc.,
• Filmed models
• Posters
• Audio - visual aids.
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69. 3] Contingency management
• Method of modifying the behavior by presentation or
withdrawal of reinforcers
• A +ve reinforcers: Henry W Fields in 1984. In this the
contingent presentation increases the frequency of
behavior.
• B –ve rein forcers: Stokes and Kennedy in 1980. In this,
the contingent withdrawal increases the frequency of
behavior this is generally a termination of an aversive
stimulus. E.g. withdrawal of the mother.

70. Behaviour Management
Audio
analgesia
Biofeedback
Voice
control
Hypnosis
Humor
Coping Relaxation
Implosion
therapy
Aversive
conditioning

71. Conclusion
• The dentist's message must be presented in terms that
correspond to the stage of cognitive and psychosocial
development that a particular child has reached.
• It is the job of the dentist to carefully evaluate the
development of the child, and adapt his or her language
so that concepts are represented in a way that the
patient can understand them.
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72. references
• Textbook of Pedodontics Shobha Tondon 2nd Edi. 2008
• Contemporary orthodontics by William Profitt 5th Edi.
2008
• Pinkham .Pediateric Dentistry; 4th ed 2005.Elsevier
• McDonald. Dentistry for the child and adolescent .8th ed
.2004;Elsevier
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73. THANK YOU !!
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