PEDODONTICS

Child Psychology

CHILD PSYCHOLOGY

Psychology science dealing with human nature,

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PSYCHOANALYTICAL THEORY

Proposed by Sigmund Freud

Freud thought the personality to originate as a

function and phenomenon of his soul in the main

result of satisfaction of sets of instincts of

which sexual instinct was most important

Importance

Helps to understand the child better

To establish effective communication with

child so as to deliver dental services in a

5 psychosexual stages (oral / anal / phallic /

latency / genital) called as erogenous zone

Components of Psychic structure

meaningful and effective manner

Id at birth, pleasure principle

To produce a comfortable environment for

Ego 2nd to 6th month of life, reality principle

dental team to work on the patients

Super Ego censor of acceptability of thoughts,

feelings & behavior

THEORIES OF CHILD PSYCHOLOGY

I.

Psychodynamic theories
1.

Psychoanalytical/Psychosexual theory

Oedipus complex

Freud (1905)

attached to the mother and they consider their

2.

Psychosocial theory Eric Erickson (1963)

3.

Cognitive theory Piaget (1952) (MAHE-

father as their enemy

01)

The name of the oedipal complex comes from

Greek mythology

II.

Young boys have a natural tendency to be

Behavioral theories

Oedipus the king of Thebe, unwittingly

slewed his father and married his mother

1.

Hierarchy of needs Maslow (1954)

2.

Social learning theory Bandura (1963)

3.

Classical conditioning Pavlov (1927)

4.

Operant conditioning Skinner (1938)

towards their father and they resent the

(MAHE-2K)

mother being close to the father

Electra complex

Similarly young girls develop an attraction

Castration Anxiety

Unconscious fear of loss of genitals

Fear of powerful people overcoming them

Fear of revenge of the powerful people

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Child Psychology

Birth

Is

Introduction

the

st

Oral stage

Anal stage

(birth to 1.5

(1.5 to 3

years)

years)

In

infants

Control

over

Urethral

Phallic

stage

(3 to 5 years)

It

is

experience to

oral cavity is

anal sphincter

transition

effect

site

results

between

personality

identifying

increased

anal

development

needs.

voluntary

phallic

Serves as a

activity

stage.

for

in

The

stage

begin during
rd

the 3 year of
and

life till the 5

th

year

Latency

Genital

(5 to 11

(11 to 13

years)

years)

Resolution of

Psychosexual

any

development

defects

occurs in this

extends from

phase.

11 13 yrs to

The

phase

ends

erogenous

21

in

young adult hood.

puberty

zone
Abrupt

This

change
birth
Characteristics

at
results

Development

Child

Characterized

child gain a

Realize goals

dependent

is

of autonomy

derives

by

sense

for

stage

and

pleasure

complex &

initiative and

reproduction

independence

from

Electra

starts

and survival

complex

adapting

since

Oedipus

in

the infant in

physiological

dependent

exercising

emergency

on adult for

control over

adverse

reaction.

getting

urinary

environment

oral

his
needs

sphincter

fulfilled

Limitations

Pessimistic and deterministic approach to

personality

Over emphasis on infantile sexuality

Overemphasis on differences between men

and women

No controlled studies-poor research

It is unconcerned with interpersonal relations,

individual identity and adaptation over ones
lifetime

PSYCHOSOCIAL THEORY

Proposed by Eric Erickson

Erickson concentrated on childs development

covering the entire span of life cycle from
infancy to childhood through old age

of

Erickson described 8 stages of life cycle which

are marked by internal crisis defined as the
turning points

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PEDODONTICS
Child Psychology

Stage 1: Basic Trust v/s Mistrust (0-1 yrs)

22

Dental visit - more curious about dentists

Dependency on mother

office, they will tolerate being separated from

Strong bond between mother & child

mother

Developing basic trust in the world

Positive outcome - secure attachment with

Achieves mastery on skills

mother

Enters

The balance of trust with mistrust depends

Sets up competition in the competitive world

largely on the quality of maternal relationship.

The

parents and environment

Stage 4: Industry v/s Inferiority (6-11 yrs)

Negative

outcome:

inattentive

maternal deprivation syndrome

frightened

Says no to every parental wishes

Parents must not overprotective

Reassurance develops confidence

If denied autonomy, the child will turn angry

are

inferiority - if discriminated, compared in

schools
Dental visit: try to please dentist and parents
& are easy to treat

Decrease in influence of parents as role

group influence

Beginning of orthodontic treatment. Wear

appliance regularly

and shamed

Stage 5: Identity v/s Role Confusion (or Diffusion")

Parental over control---muscular and anal

(12-21 yrs)

Development of personnel identity

child

The adolescent is newly concerned with how

Dental visit provide options to the child &

impotencedoubt
Separation

of

mother

leaves

the

threatened

they appear to others.

make him feel more important, let mother be

promise of a career.

Stage 3: Initiative v/s Guilt (3-6 yrs)

Greater

Ego identity (confidence that the inner

sameness and continuity) as evidenced in the

with

autonomy,

increased

Preoccupation with appearance

Easily influenced by people considered as

physical

idols

activities
Initiates motor and intellectual activities,
planning, and undertaking tasks.

Imitates the people he likes / respects

Depends on how much freedom child will get

& intellectual curiosity is satisfied

technology

models with simultaneous increase in peer

of

Failure results in isolated, less conscious,

fundamentals

Learns the pleasure of work completion

themselves - self control, confidence

of

Toddler learns to talk, walk, use toilets

(control over sphincters) and do things for

program

Moves away from mother and develops a

sense of individual identity

organized

developed

Stage 2: Autonomy v/s Shame and Doubt (1-3 yrs)

learning, ability to work

Such patients are highly uncooperative &

School

Increased Group identity and peer group

influence

Inability to separate from peers results in

confusion, inability to make decision &
choices.

Play with peers and learn to interact with

Most orthodontic treatments carried out in

this age more conscious about appearance

environment

Feels guilt over failure to attain goals, which

makes the child feel unable to be independent

Stage 6: Intimacy v/s Isolation (21-40 yrs)

Development of intimacy (attain intimate

Develops sibling rivalry

The castration complex occurring in this stage

Involved in intense and long term relations

is due to the child's erotic fantasies.

Loves to work

relationship with others)

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Child Psychology

Tries to achieve goals

The avoidance of these experiences leads to

isolation and self-absorption.

Now true genitality can fully develop.

The counterpart of intimacy is dinstantiation,

which is the readiness to isolate and destroy
forces and people considered as competitors

Inability to develop identity---fear to form a

committed relationship

The danger at this stage is isolation which can

lead to severe character problems.

Stage 7: Generativity v/s Stagnation (40-65 yrs)

Generativity is the concern in establishing and

guiding

the

next

generation.

Fruitful

parenting

Look outside one & care for others

Generativity cant be achieved by simply

having or wanting children.

Erickson stated that adults need children as

much as children need adults

Generativity is expressed through Sociallyvalued work and disciples

Creation of living legacy

If not - self concerned people, isolation, and

absence of intimacy all of which results in
stagnation

Stage 8: Ego Integrity v/s Despair (>65yrs)

Ego

integrity

is

the

ego's

accumulated

assurance of his capacity for order and

meaning.

It is the sense of satisfaction of achieving goals

or success

Despair

is

loss

of

hope

producing

misanthropy and disgust

Signified by a fear of one's own death, as well

as the loss of self-sufficiency, and of loved
partners and friends

Erikson: Healthy children won't fear life if

their elders have integrity enough not to fear
death.

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PEDODONTICS
Child Psychology

Age
(years)

Ericksons

Freuds Psychological

Psychological Stages

Stages

(Psychosocial)

(Psychosexual)

Developmental Characteristics
(significant relations)
Attachment

01

Basic Trust v/s Basic

Oral phase

Mistrust

(Infancy)

Sensomotoric intelligence
Motor functions
Continuity of existence
Parents
Language development

23

Autonomy v/s Shame

Anal stage

and doubt

(early childhood)

Self control
Motor function
Play and imagination
Parents
Creativity
Self awareness

Phallic Stage
45

Initiative v/s guilt

(Oedipal phase, late

childhood)

Moral development
Problem solving/activity
Gender identification
Play in groups
Parents and peers
Practical / Problem solving

6 12

Industry v/s

Latency Stage

Inferiority

(early school age)

Learning skills
Learning knowledge working together
Self evaluation family of origin / School
Peers, others
Self image / identity
Abilities / possibilities
Formal operational thought

13 18

Identity v/s Role

Genital Stage

Group activity / identity

confusion

(teens)

Gender activity / identity

Gender role / relation with the opposite sex
Physical maturity
Family of origin / peer group
Married life

19 25

Intimacy v/s Isolation

Relation to children working relation

Relation to values of life
Own family / colleagues, friends
Family structure / function

26 50

Generativity v/s
Stagnation

Child rearing
Working situation involvements in society
Own family / colleagues / groups of interests

50 +

Ego Integrity v/s

Despair

Reflection

Winding up
Own family

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PEDODONTICS
Child Psychology
COGNITIVE THEORY (KCET-99)

used

to

25

the

dental

teams

by

giving

dental

Proposed by Jean Piaget in 1952

advantage

According to Piaget, the environment does not

instruments and equipment life

shape child behavior but the child and adult

like names and qualities.

o

actively seek to understand the environment

Constructivism child acquires

This process of adaptation is made up of 3

reality by touching, exploring,

functional

observing

variants

Assimilation,

Accommodation and Equilibration

Piaget

describes

stages

in

cognitive

3.

Concrete operation (6-12 years)

development

Logical capacity grows

1.

Sensory motor stage (0-2 years)

Good answering / reasoning capacity

Reconstructs objects

Decline of egocentrism

Memory by mental images

Decline of animism

Develops rudimentary concepts of

Thinks much more like adults

objects

Easy to treat

Making operation in ones head out

Objects

in

the

environment

are

permanent; do not disappear when

from perceived reality (COMEDK-08)

the child is not looking at them.

Communication between a child at

4.

this stage and an adult is extremely

Good communication skill

limited because of the childs simple

Ability to deal with abstract concepts

concepts

and

lack

of

language

& reasoning

capabilities.

Formal operation stage (12-15 years)

Little ability to interpret sensory data

treated as adult

and a limited ability to project

forward or backward in time.
2.

Good language development

Capacity to form mental symbols

represent things and events

Concept of imaginary audience

constantly on stage

Preoperational (3-6 years)

Child is a teenager & should be

Easy to treat if interested

Orthodontic treatment and concept

of imaginary audience

CLASSICAL CONDITIONING THEORY

Children learn to use words to

By Ivan Pavlov

symbolize the objects.

Classical conditioning operates by a simple

Understand the world in the way

process of association of one stimulus with

they sense it through its primary

other

senses: sense of vision, hearing,

Learning by association

smell, taste or feel

Experiment: Presentation of food to a hungry

Child learns to classify things

Solves problem, but cannot explain

dog

how it solved
Characteristics
o

Egocentrism child is incapable

Three steps

Conditioning

Stimulus generalization

Extinction

Stimuli

of assuming another persons

1.

Neutral stimulus (NS)

point of view.

2.

Unconditional stimulus (US)

inanimate

3.

Unconditional response (UR)

objects with life. Animism can be

4.

Conditional stimulus (CS)

Animism investing

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5.

Conditional response (CR)

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After extinction

Before conditioning

FIRST VISIT

White Coat

No Response

(Neutral stimulus)

(No response)

Conditioning process

Pain of Injection
(Unconditioned stimulus)

Fear and Crying

(Unconditioned response)

SECOND VISIT
Sight of White Coat

(Conditioned stimulus)

Fear and Crying

(Conditioned response)

OPERANT CONDITIONING

After conditioning

Proposed by B.F Skinner

Extension of Classical Conditioning Theory

Complicated theory

Related to trial and error learning

A person attempts to solve a problem by

trying different actions until one proves
successful

Extinction
Before extinction

Instrumental conditioning

The Basic Principles

1.

Operant behaviors are voluntary

2.

The consequence of a behavior is in itself a

stimulus that can affect future behavior

Extinction process

3.

Teach new behaviours (behaviour shaping)

Classical conditioning - a stimulus leads to a

response

Operant conditioning - a response becomes a

further stimulus.

Types
1.

Positive reinforcement

If a pleasant consequence follows a

response

Ex. reward for co-operation

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Child Psychology
2.

3.

Negative reinforcement

food, sleep, sex, etc. When not satisfied - feel

after a response

sickness, irritation, pain, discomfort

Ex. Stopping treatment if crying

Removal of a pleasant stimulus after a

insurance policies etc

Ex. Taking out of favorite toy

When

an

unpleasant

stimulus

is

version of these needs is low self-esteem and

Ex. Sending mother out of operatory

inferiority complexes.

1 & 2 are more suitable for dental office

1.

Presenting food, candy, toys

Activity

the

child

likes

one is capable of becoming"

Social reinforcer (giving attention,

Negative reinforcers

Halting

have

everything

can

They can seek knowledge, peace, self-

because

of

They

are

reality
respect

centered,

behavioral resistance is likely to

centered,

reinforce undesirable behavior

accompanied with strong ethics.

self

and

problem
others

3 & 4 should be used sparingly with some

SOCIAL LEARNING THEORY

Voice control and HOME are mild forms

Proposed by Bandura (1963)

of punishments

The learning of behavior is affected by 4

Physical restraints

principal elements
1.

HIERARCHY OF NEEDS
Abraham

Antecedent determinant conditioning is

affected if the person is aware of what is

Harold

Maslow

established

Hierarchy of needs by observing basic needs

who

fulfillment, oneness with God etc.

treatment

caution (Aversive learning) Punishers

People

maximize their potential.

praise, smiling)
2.

The need for self-actualization is "the

desire to become more and more what

(permission to leave the dental chair)

Self actualization

Positive Reinforcers - immediate

which

Esteem needs: Self esteem by mastery of

tasks, respect from others. The negative

presented after a response

Social needs/Love & belonging needs: Loving

and caring partners, children, friends, society

Punishment

Safety needs: stability & constancy in a chaotic

world. Ex. security of home & family,

particular response
4.

Physiological Needs: basic needs - air, water,

Withdrawal of an unpleasant stimulus

Omission (time out)

27

occurring
2.

Consequent

determinant

persons

of individuals.

perception and expectancy (cognitive

He believed that violence exists to fulfill the

factors) determine behavior

basic needs

3.

Modeling learning through observation

eliminates the trial-error search. It is not

Self
actualization

an

automatic

process,

but

requires

cognitive factors
Self esteem

Social

Security

4.

Self regulation this system involves a

process of self regulation, judgment and
evaluation of individuals response to his
own behavior

Physiological needs

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EMOTIONAL DEVELOPMENT

Fear evoking dental stimuli

Characteristics of commonly seen Emotions in

The most feared events in dental clinic can be

ranked as

Distress or Cry

Anesthetic administration by injection

Anger

Extraction

Fear

Sound of drill

Anxiety

Phobia

Anxiety

Emotion arising without any source of danger

It is a learned process being in response to

Frightened cry - Usually accompanied by

ones environment

torrent of tears, breath-catching sobs

Child

Types of Cry (Elsbach, 1963) (KCET-04)

Hurt cry - Initially a child in discomfort, shows

Maternal anxiety plays an important role in

childs anxiety level determinant

a single tear filling from corner of the eye

Obstinate cry - characterized by siren-like wail

Compensatory cry - is a sort of coping

Growth & development

mechanism

Family & Peer influence

Past medical/dental history

Dental office environment

Fear

Factors influencing child behavior

Fear is a reaction to a known danger (MAHE94)

Dental team requirements (AIPG-91, 98)

At birth - is a primary response acquired

Positive approach

soon after birth such as startle response

Team attitude

Pre-schooler (2-5 yrs) - Fear of animals or

Organization

being left alone or abandoned (AIIMS-91,

Truthfulness

AIPG-98, COMEDK-10)

Tolerance

Early schooler - Fear of dark, staying alone.

Flexibility

Shows fear of supernatural powers like

ghosts and witches

Lampshires Classification

Late schooler - Fear of failure, not being

1.

Cooperative

liked,

2.

Tensely cooperative

3.

Outwardly apprehensive

Adolescent - Fear of social rejection and

4.

Fearful

fear

group

5.

Stubborn

pursuits).

6.

Hyper motive

7.

Handicapped

8.

Emotionally immature

competition,

and

fear

of

punishment

of

performance

pressures,

academic

(peer

(KCET-01, AIPG-03)

Innate fear Without stimuli or previous

experience

Subjective

fear

Fears

transmitted

to

individual are termed as subjective fears.

28

Objective fear Fears due to events, objects or

specific conditioning, previous experience

Frankels Behavior Rating Scale

1.

Rating I

(dental trauma) or generalization (medial

Definitely negative

experience).

--

2.

Rating II

Negative

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3.

4.

Rating III

Positive

Rating IV

Definitely positive

++

Wilsons Classification
1.

Normal / Bold

2.

Timid

3.

Hysterical

4.

Nervous / Fearful

Wrights Classification
Cooperative behavior

Uncooperative behavior

Lacking

Hysterical

Cooperative

behavior

Defiant/obstinate behavior

Potentially cooperative

Tense cooperative
Timid / shy
Whining type
Stoic behavior

Maternal attitude & Childs behavior

Mothers behavior
Overprotective
dominant
Over indulgent
Under affectionate

Childs behavior
-

Shy, submissive
Aggressive, demanding
Usually well behaved, shy, may
cry easily

Rejecting

Aggressive, over active

Authoritarian

Evasive & dawdling

*****

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