Child psychology /certified fixed orthodontic courses by Indian dental academy

CHILD
PSYCHOLOGY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Structure of the presentation
• Introduction
• Theories of Emotional Development
• Emotional Development and Its Relation to
cooperation in Treatment
• Patient compliance
• Behaviour management of child

CHILD PSYCHOLOGY
The part of developmental psychology
which traces the changes in behaviour
occuring during the early years of life.

Stone and Church’s classification
• Infant : till 15 months
• Toddler :5 months to 2 years of age
• Preschooler : 2 to 6 years of age
• Middle year child : 6 to 12 years of age
• Adolescent : 12 years till maturity.

Theories of Emotional Development
 Stanely Hall{1846-1924} : founder of Emotional
development and Psychology.
 "Theories are nothing but more than a set of
Concepts and Propositions that allow the
Theorist to describe and explain some aspects
of experience".

• Jean Piaget (1896 - 1980)

Intellectual Growth
Intellectual growth involves three
fundamental processes:
• assimilation,
• accommodation,
• and equilibration

ASSIMILATION ACCOMODATION
Modification of
one’s environment
to fit into an
already developed
cognitive structure.
Modification of
one’s cognitive
structure to fit in
with characteristics
of the environment

• This dual process, assimilation-
accommodation, enables the child to
build-up various hierarchies of related
behavior, which Piaget called Schemata.
• Equilibration: involves the person striking a
balance between them-self and the
environment, between assimilation and
accommodation.

Piaget's theory delinates four phases of
cognitive growth and the processes by
which children progress through them.
The four stages are:
• Sensorimotor stage
• Preoperational stage
• Concrete operational stage
• Formal operational stage

SENSORIMOTOR STAGE
• The period between birth to 2 years was
labelled as “Sensorimotor stage” by
Sir Jean Piaget.
Characterized by:
development of object permanence.

Object Permanence.
• A child’s
realization that
objects continue
to exist even
when they are
hidden from view.

PRE-OPERATIONAL STAGE
• The period between about the ages 2-7
years was labelled as “pre-operational
stage” by Sir Jean Piaget.
• Characterised by:
Egocentrism
Animism/ representational thoughts
Identity concept
Transductive reasoning

Egocentrism
• Inability to adopt
another person’s
point of view.
• Because of this the
child can only manage
his own perspective
and assumes
another’s view is
simply beyond his
mental capabilities.

egocentrism altruism sympathetic

Altruism
• Giving and sharing objects, time, or goods
with others with no obvious self-gain.

Animism
• A child’s belief that all
things are living and have
feelings and intentions just
as we (humans) do.

Representational thoughts
• Capacity to form mental symbols which
stands for objects or events that are not
actually present.
• Manifestations ….

APPLICATIONS OF PRE-OPERATIONAL
STAGE
• There is also no point talking to a 4
year old about how much better his tooth
will look in the future if he stops
thumsucking.
• At the same time it would not be
useful to point out to the child how
proud his father would be if he stopped
thumsucking, since the child would think
his fathers attitude was same as the child
(Egocentrism).
• Telling him that the teeth will feel better
now or talking about how bad his
thumb tastes.

CONCRETE-OPERATIONAL STAGE
• The period between about the ages 7-11 years
was labelled as “concrete-operational stage”
by Sir Jean Piaget.
• Characterised by:
Conservation
Coordination of 2-dimensions
Seriation
Sequencing
Reversibility

Seriation, centering
• Centering : paying
attention on the single
most striking feature
and ignoring it’s all
other features.

FORMAL-OPERATIONAL STAGE
• The period between about the ages 11years
to adults was labelled as “formal-
operational stage” by Sir Jean Piaget.

Major works
• Introduction to Genetic Epistemology (1950)
• Play, Dreams, & Imitation (1951)
• Origins of Intelligence (1952)
• Constructions of Reality (1954)

SIGMUND FREUD
1856-1939
“I was the only worker in a new field.”
.

Born in Freiburg in Moravia
View of Freiburg

psychoanalytic theory
Theory of
personality
structure
Theory of
personality
dynamics
Psychosexual
theory of
cognitive
development

Freud’s Psychosexual Stages
• STAGE
Oral (0-18 months)
Anal (18-36 months)
Phallic (3-6 years)
Latency (6 to puberty)
Genital (puberty on)
• FOCUS
Pleasure centers on the mouth-sucking, chewing,
biting
Pleasure focuses on bowel and bladder elimination;
coping with demands for control
Pleasure zone is the genitals; coping with incestuous
sexual feelings
Dormant sexual feeling
Maturation of sexual interest

Important Psychosexual Stage Theory Vocabulary
• Anal personality- overemphasis by adults on toilet training
results in compulsion obstinate and perfectionist behaviour in
later life which is called Anal personality
• Electra complex: affectional responces by a girl toward her
father accompained by jealousy of her mother.
• Oedipus complex-a boy’s sexual desires toward his mother and
feelings of jealousy and hatred for the rival father(penis envy).

• Fixation-a lingering focus of pleasure-seeking energies at an
earlier psychosexual stage, where conflicts were
unresolved.(Portion of libido is stuck in 1 stage because of
excessive frustration or gratification)
• Identification-the process by which, children incorporate their
parents’ values into their developing superegos.

Drawbacks of Psychosexual theory
• Overemphasis on
sexuality.
• Role of society is
completely ignored.
• Female psychology is
not taken into
account (KAREN
HORNEY, feminine
psychology 1967)

Major works
• Studies on Hysteria (with Josef Breuer) (Studien über Hysterie, 1895)
• The Interpretation of Dreams (Die Traumdeutung, 1899)
• The Psychopathology of Everyday Life (Zur Psychopathologie des Alltagslebens,
1901)
• Three Essays on the Theory of Sexuality (Drei Abhandlungen zur Sexualtheorie,
1905)
• Totem and Taboo (Totem und Tabu, 1913)
• On Narcissism (Zur Einführung der Narzißmus, 1914)
• Beyond the Pleasure Principle (Jenseits des Lustprinzips, 1920)
• The Ego and the Id (Das Ich und das Es, 1923)
• The Future of an Illusion (Die Zukunft einer Illusion, 1927)
• Civilization and Its Discontents (Das Unbehagen in der Kultur, 1929)
• Moses and Monotheism (Der Mann Moses und die Monotheistische Religion, 1939)
• An Outline of Psycho-Analysis (Abriß der Psychoanalyse, 1940)

Eric Erickson’s view

Eric Erickson
• Trust versus mistrust
• Autonomy versus shame
• Initiative verses guilt
• Industry verses inferiority
• Identity versus role- confusion

Trust versus mistrust
Development of the basic
Trust depends on caring
and consistent mother or
mother substitute, who
meets both the physiologic
and emotional needs for
the infants. The strong
bond between mother and
child is necessary for the
child to develop a Basic
trust in the world.

Maternal Deprivation Syndrome
When the child receives inadequate maternal
support, it will fail to gain weight and are
retarded in both physical and emotional
growth. This is seen in children of broken
families or who lived in a series of foster
homes.

Autonomy versus shame
• Autonomy : confidence
in oneself.

Autonomy versus shame
• Shame: a feeling of
having all ones
shortcoming exposed.
e.g Bowel control

TERRIBLE TWOS
Little devil Little angel
He says NO to every wish
of parents and insists on
having his own way.
He retreats to parents in
moments of dependence.

Initiative verses guilt
• Initiative : to plan, to
start-up and to
perform a task.

Initiative verses guilt
• Guilt: feeling of
fear that ones
activities might
not be acceptable

• Features of this age are: Extreme curiosity
and questioning, aggressive talking, physical
activity.
• A major task for parents and teacher at this
stage is to channel the activity into
manageable tasks, arranging things so that
child is able to succeed, and preventing him or
her from undertaking tasks where success is
not possible.

Industry verses inferiority
• Industriousness : to learn
about the rules by which the
world is organized and to
acquire the academic and
social skills that allow him to
compete in the environment

Identity versus
role- confusion/ identity
diffusion
• Identity : searching for
continuity and sameness in
oneself.
• During this period, they rebel
against the set-rules and
norms.

TURMOIL OF ADOLESCENCE
security and
comfort of
childhood.
privilege and
responsibilities of
adulthood

Psycho-orthodontic theory
This theory was put forwarded by El-Mangoury.
Motivation is a very broad psychological term which
describes a hypothetical construct which aims to
explain the reason for the stream of a goal-directed
behavior driven by specific or nonspecific forces.

• A) Achievement motivation : the motivation
characterized by striving for success in any
situation in which standards of excellence
apply.
• B) Attribution motivation : the motivation for
perceiving the causes of success and failure,
either internally (that is, to the self) or
externally (that is, outside the self).

C) Affiliation motivation of orthodontic patients was
defined as a hypothetical construct of seeking
orthodontic care for the purpose of improving the
dento facial esthetics in order to facilitate the
connection or association of oneself with other people
for obtaining, maintaining, and/or restoring close
interpersonal relationships.

Emotional Development and Its Relation to
cooperation in Treatment
Patients usually expect improved dental facial appearance as an
outcome of the treatment, but factors like co-operation play a
major role.
 AJO 1992 Nanda showed female adolescent patients showed more
cooperation than male patients.
 Adolescence Shows less cooperation because of the establishment
of social and developmental issues, personal values and goals. Thus
the relative strength of peers and parental influences are changing
during adolescence maturation.

 AJO 1985 Gross reported adolescence have negative perception of
orthodontic treatment and parental support is critical to treatment
success
 EJO 1990 Kegeles reported children whose parent encouraged
treatment were generally cooperative. Cooperation was still higher
for adolescent patient whose parents express positive attitudes
towards orthodontic treatment.

HOW ORTHODONTIC TREATMENT
AND ORTHOGNATHIC SURGERIES
INFLUENCE THE EMOTIONAL
STATUS OF THE PATIENT ?

• Rivera and Hatch SEM in orthodontics 2000
evaluated emotional status of the patient before
and after orthodontic and orthognathic surgery
patients and concluded;
• BEFORE TREATMENT :
 Individuals with mild facial disfigurement was
affected more than severe deviation.
 60% believed self confidence,social
acceptance,communication and body image will
improve after treatment.

IMMEDIATELY AFTER SURGERY:
Immediately after surgery negative mood last
for 4-6 weeks because of pain, numbness and
oral function problems but it was recovered
within 3 months.

AFTER ORTHOGNATHIC SURGERY :
Patient after orthognathic surgery showed more
positive benefits with increased self judgement
self esteem, self confidence and body image
when compared with orthodontic alone treated
patients.
 Social potency, social responsiveness social
interaction, and behavior improved after surgery.

PATIENT COMPLIANCE
• The success of orthodontic therapy frequently
depends on patient compliance.
• EGOLF and others described a compliant
patient as one who practices good oral
hygiene, wears appliances as instructed
without abusing them, follows an appropriate
diet, and keeps appointments.

ACHIEVING PATIENT COMPLIANCE
• ROSEN provided a practical patient-oriented
approach to creating a compliant patient.
• Health care providers should develop a
compliance model that is patient-centered
rather than clinician-centered.

PERSONALITY TESTING AND
COMPLIANCE
• Major orthodontic treatment decisions are based
on an anticipated level of patient compliance.
• PERSONALITY TEST:
• SOUTHARD et al
• “The Millon Adolescent personality inventory”
(MAPI) (MILLON, GREEN, and MEAGHER-1982)
• To predict the behavior of adolescent patients in
an orthodontic practice.

Methods of improving patient
compliance
(A.O. 1998 No. 2, T. Mehra, R.S. Nanda, P.K Sinha.)
Verbally praising the patient,
Discussing treatment goals and poor patient
cooperation with the patient and parent.
Educating the parent about the use of
orthodontic appliances, and about the
consequences of poor compliance.

Methods of improving patient
compliance
• JCO 1996 Sep MELVIN MAYERSON,
R.G “WICK” ALEXANDER
• Patient Education
• Patient Motivation
• Office Environment
• Communication Techniques
• Monitoring Progress

ORTHODONTIST AND PATIENT
COMMUNICATION
• KLAGES, SERGL, and BURUCKER – found strong
relationships between clinician’s encouraging
behavior and patient communication
cooperation, and concluded that the
orthodontist's behavior may be relevant for
patient verbal cooperation.
• The doctor-patient interaction is the best
predictor of how well a patient could be expected
to comply with the doctor’s instructions.

Communication Techniques
An effective communication technique is to look in their eyes
before you look in their mouths.
• "Horizontal communication": Dr. J. Moody
Alexander looking in patient's eyes before
looking in the mouth.
• Good communication should be honest
as well as two-way, the orthodontist
should be “askable”.

Patient Motivation
• WILLIAM JAMES “The most important
discovery of the 20th century is that the
attitudes of an individual can change”.
• The only truly motivational technique is self-
motivation

BEHAVIOUR MANAGEMENT OF CHILD
1. Non-pharmacological (psychological approach)
2. Pharmacological
• Non- pharmacological:
1. Communication
2. Behavior shaping (modification)
• Desensitization
• Modelling
• Contingency management

BEHAVIOUR MANAGEMENT OF CHILD
3. Behavior management
• Audio analgesia
• Biofeed back
• Voice control
• Hypnosis
• Humor
• Coping
• Relaxation
• Implosion therapy
• Aversive conditioning.www.indiandentalacademy.com

BEHAVIOUR MANAGEMENT OF
CHILD
• Pharmacological:
1. Pre-medication
• Sedatives And Hypnotics
• Anti-anxiety Drugs
• Anti-histamines
2. Conscious sedation
3. General anesthesia.

CONCLUSION
• Books only superficially touches the
psychology of a child, the best way to
learn child psychology is through child-
interaction.

Sources
• Bakken, L.; Thompson, J.; Clark, F. L.; Johnson, N.; Dwyer, K. (2001). Making
• conservationists and classifiers of preoperational fifth-grade children. Journal
• of Educational Research, 95, 56-57.
• Cairns, T. (2001). How acquiring basic skills should be part of everyday life. Adults
• Learning, 13, 20-22.
• Gale. (2001). Cognitive development. Encyclopedia of Psychology (2nd ed.). New
York.
• Weiten, W. (2001). The growth of thought: cognitive development. Psychology
• Themes and Variations (5th ed.). 336-340.
• Kalat, J. W. (1996). Introduction to psychology. Pacific Grove, CA: Brooks/Cole.
• Baillargeon, R. (1994). How do infants learn about the physical world? Current
• Directions in Psychological Science,

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Child psychology /certified fixed orthodontic courses by Indian dental academy

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