CHILD PSYCHOLOGY

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

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Socha hi na tha ki jeene ke liye dard
sambhalane honge.. Muskuraney ke liye
dard bhulane honge.. Isi dard mein
muskuraney ...
CONTENTS
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INTRODUCTION.
DEFINITIONS.
THEORIES OF CHILD PSYCHOLOGY.
CLASSIFICATIONS.
EMOTIONAL DEVELO...
WHY PSYCHOLOGY???
 Psychological development is a dynamic process
 Governed by genetic, familial, cultural,
interpersona...
Definitions
 Psychology: The science of the human soul;

specifically, the systematic or scientific knowledge of
the powe...
Definitions…
 Emotions: An effective state of consciousness in

which joy, sorrow, fear, hate or the likes are
expressed
...
Definitions…
 Behavior- any change observed in functioning of

organisms.

 Behavior management- means by which dental

...
Importance of child psychology
 Better understanding of the child

 Know problems of psychological origin
 Deliver dent...
Importance of child psychology
 Gain confidence of child & parents

 Better teaching of primary & preventive care
 Effe...
Classification
Theories of child
psychology

PSYCHODYANAMIC

Psychosexual theory
Psychosocial theory
Cognitive theory

BEH...
 Psychodynamic theories:
 Psychosexual theory- Sigmund Freud (1905)
 Cognitive development theory- Jean Piaget
(1952)
...
Psychosexual/Psychoanalytical Theory

Sigmund Freud (1905)
 Attempts to explain the

personality & psychological
disorder...
Psychosexual/Psychodynamic Theory
• Described 6 stages–

•

oral
anal
urethral
phallic
latency
genital

At each stage sexu...
Topographical model
 MIND AS AN ICEBERG…

Consists of….. ,,,,,,,
conscious,
preconscious &
subconscious mind

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Only 10% of an iceberg is visible (conscious)
whereas
the other 90% is beneath (unconscious)
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Conscious mind
 The conscious mind is where

we are paying attention
at the moment…
 Only our current thinking processes...
Preconscious mind
 Ordinary memory & knowledge
 Those things of which we are aware, but where we

are not paying attenti...
Unconscious/Subconscious mind
 The process and content are

out of direct reach of the
conscious mind.
 Thinks and acts ...
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PSYCHIC TRIAD/MODEL
SUPER
EGO

EGO

ID

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Structural mind
 An individual’s feelings, thoughts, and behaviors are

the result of the interaction of the id, the ego ...
ID – Pleasure principle
 Basic structure of personality

which serves as reservoir of
instincts or mental representative....
Ego
 The rational part of the mind.
 Develops out of ID in 2-6 month, when infant distinguish

between itself and outsid...
Super ego
 Prohibition learned from environment ( parents & society)
 Acts as censor of acceptability of thoughts , feel...
 In a healthy person the ego is the strongest

it can satisfy the needs of the id
not upset the superego
still take into ...
Ego defense
mechanisms
 These are tactics which the Ego develops to help

deal with the ID and the Super Ego
 All Defens...
EGO DEFENCES
ANXIETY

When become overwhelming , EGO must defend itself.

It does so consciously by blocking impulses EGO
...
Displacement:
 Redirecting our impulses (often anger) from the real

target (because that is too dangerous) to a safer bu...
Projection:
 Attributing one's own unacceptable thoughts,

feelings, impulses to others.
 Person having aggressive feeli...
Reaction formation
 Reversal of our feelings, overacting in the opposite

way to the fear.

Loose temper

Laugh to preven...
Regression:
 Giving up of mature problem-- solving methods in

favor of child like approaches to fixing problems

www.ind...
REPRESSION
PRIMARY REPRESSION

PRIMAL REPRESSION

Expulsion of thought
and memories that
might provoke anxiety
from consci...
Rationalization:
 Giving excuses for shortcomings and thereby

avoiding self-condemnation, disappointments, or
criticism ...
DENIAL
 Person may deny(refuse) some aspect of reality.

Big ulcer in mouth

Diagnosed as carcinoma
Not able to tackle, c...
Psychosexual Stages of Development
 Failures to set satisfying needs/goals at any stages

of psychosexual development lea...
Oral Stage (0 - 1.5 yrs )
 Erogenous Zone in Focus: Mouth
 Gratifying Activities: eating, sucking,

gumming, biting & sw...
Oral fixation

 Both insufficient and forceful feeding can result in

fixation in this stage
 Symptoms of Oral Fixation:...
Anal Stage (1.5 – 3 yrs)
 Erogenous Zone in Focus: Anus

 Gratifying Activities: Bowel movement and the

withholding of ...
Anal Fixation
Anal-Expulsive
Personality
If the parents are too
lenient, the child will
derive pleasure and
success from t...
URETHRAL STAGE (3-4 yrs)
 Transition between anal & phallic
 Derives pleasure by exercising control over urinary

sphinc...
Phallic Stage(4-5 yrs)
 Probably the most challenging

stage in a person's psychosexual
development
 "Oedipus Complex" (...
Phallic Stage
Objectives:
 Child realizes the sexual qualities without
embarrassment.
 Resolution of the stage in regula...
Latency Stage(6-12y)

 Sexual feelings are suppressed to allow children to

focus their energy on other aspects of life
...
Latency Stage
 Resolution of any defects
 Maturation of ego
 Greater control over instincts
 Consolidation of sex role...
Genital Stage (puberty onwards)
 Erogenous Zone in Focus: Genital
 Gratifying Activities: heterosexual

relationships
 ...
Fixation
 If people experience difficulties at this stage, and

many people do, the damage was done in earlier
oral, anal...
WHAT IS GOOD ABOUT THIS THEORY?
 One of the first theories proposed in psychology

 Stage wise classification help us to...
WHATS NOT SO GOOD ABOUT THIS
THEORY?
 Based only on the sexual drive
 Based on studies conducted on few patients

 Comp...
PSYCHOSOCIAL THEORY: ERIK
ERIKSON 1963
 Infancy

childhood

old age

 Development depends on child’s instincts and

resp...
PSYCHOLOGICAL
CRISIS

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1. Basic trust Vs basic mistrust ( hope )
Birth- 18 months
 First trust of INFANT

MOTHER ( caregiver)

Well handled

adl...
2. Autonomy Vs Shame( will ) 18
months- 3yrs
 TODDLER begins to push for INDEPENDENCE
 Terrible two’s.
 Well parented c...
3. Initiative Vs Guilt(purpose) 3-6 yrs
 Child becomes more assertive ; resulting conflict cause GUILT .

HEALTHY CHILD L...
4.Industry Vs Inferiority ( competence)
7-11 yr
 Child learns basic culture skills – school skills
 The child who, becau...
5. Identity Vs Role Confusion(Fidelity)
12-17 yrs
 Child now is ADOLESCENT.
 Learns how to answer satisfactorily and hap...
6.Intimacy Vs Isolation( love)
 The successful YOUNG ADULT.
 Intimacy

good marriage.
friendship.

 In this stage exter...
7.Generative Vs Stagnation(care)
 In adulthood, the psychosocial crisis demands

generatively, both in sense of marriage ...
8.Integrity Vs Despair(Wisdom)
 MATURE ADULT.
 Peak of adjustments, integrity.
 He/she trusts, independent and dares th...
PSYCHOSOCIAL THEORY
MERITS
 Age wise,, so easy to

DEMERITS
 Based on extreme ends

apply to any stage.
 Simple and

co...
COGNITIVE DEVELOPMENT THEORY- JEAN PIAGET
(1952)
 How children and adolescent think and acquire
knowledge.
 Derived from...
Adapt to new
information

Assimilation
•Reinterpret new
experiences so they
EQUILIBRATION
fit into old ideas.
•Existing id...
Piaget’s Periods of Cognitive Development
Birth to 2
years

Sensori-motor

Uses senses and
motor skills, items
known by us...
Cognitive development theory
MERITS
 Most comprehensive.

DEMERITS
 Underestimates ability.
 Overestimates age

differe...
Classical conditioning – Pavlov (1927)
 Russian psychologist Ivan Petrovich Pavlov – first to

study conditioned reflexes...
Classic Ivan Pavlov experiment
A simple three step example which shows the
important elements of conditioning:
 Step 1: B...
 Step 2: The conditioning process

Neutral
stimulus

Unconditional
stimulus

Note: Repetition of this is done at each tim...
 Step 3: After conditioning

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How can we apply to Dentistry???....
 First visit

White coat
(Neutral stimulus)
Pain of injection
(Unconditioned stimulu...
Once conditioned response has established,, its necessary to
reinforce it occasionally to maintain it.

ACQUISATION -- GE...
Operant Conditioning Theory
 SKINNER B.F ( American psychologist)
 Also called as Instrumental Learning.
 Extension of ...
 Four basic types of operant conditioning:

(distinguished by the nature of the
consequence.):
1. Positive reinforcement
...
:
Positive reinforcement
A pleasant consequence follows a response.
A child is given a reward such as a toy for
behaving...
Negative reinforcement


Involves the withdrawal of an unpleasant stimulus after
a response.

 Leads to the removal of a...
Omission (also called time-out):


Involves removal of a pleasant stimulus after a
particular response.



Favorite toy ...
Punishment:
 Occurs when an unpleasant stimulus is
presented after a response. This also decreases

the probability that ...
Social Learning Theory
 Albert Bandura
 Emphasizes the importance of observing and
modeling the behaviors, attitudes, an...
 General principles of social learning theory are as

follows:
1. People can learn by observing the behavior of others
an...
 Observational learning is also known as
Imitation or Modeling.
 Learning occurs when individuals observes and
imitate o...
EFFECTS OF MODELING ON
BEHAVIOR
 Modeling teaches new behaviors.
 Modeling influences the frequency of previously

learn...
Hierarchy Of Needs
 Maslow believed in self-actualization theory.
 Based on totality of personality development.

 But ...
Hierarchy Of Needs- 1954
 Abraham Harold Maslow

To achieve one’s full potential

To be competent and recognized

To love...
Emotional development
 EMOTION is a state of mental excitement characterized

by physiological, behavioral changes and al...
CRY:
 Elsbach 1963

TYPES
 Obstinate cry
 Frightened cry
 Hurt cry
 Compensatory cry

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OBSTINATE CRY

 Temper tantrum
 Loud, High-pitched, Siren-like

 Form of emotionally aggressive behavior
 External res...
HURT CRY
 May be loud or a small whimper
 Single tear – First indicator
 Most easily recognized as the child
acknowledg...
ANGER: Outburst of emotion caused by child’s lack of
skill in handling situation.
ANXIETY: Its emotion similar to fear but...
Behavior: any change observed
in functioning of an organism.
Frankel’s classification(1962):
1. Def –ve (- -) : refuses, c...
Reaction to the first dental visit
 Major Hurdles..
 Fear of separation
 Maternal Anxiety
 Child’s dental awareness
 ...
PSYCHOLOGICAL MANAGEMENT
 Orthodontic treatment initiated during pre-pubertal

or early pubertal developmental period of ...
PSYCHOLOGICAL MANAGEMENT OF
PATIENT BY SPECIFIC AGE GROUPS

1. YOUNG CHILD FROM 6-9YRS

 Attempt to break infantile habit...
2. EARLY ADOLESCENT ( 10-13 YRS)
 Sexual differences become more important in girl

child.
 A boy will look for male ide...
 Explain each treatment procedure.
 If you show care for young patient , he will care for

you being co-operative.
 Fem...
 Some times it may end up with CRUSH

SYNDROME– which is difficult management
problem.
 This behavior must be discourage...
3. TEENAGER( 14-18YRS)
 Teenage male wishes to be treated as adult.
 Management of teenage male is a matter of

sympathy...
MOTIVATION AND CO-OPERATION
 Patient cooperation is an essential factor in the

timely, successful outcome of orthodontic...
 Girls reported greater willingness to cooperate with

orthodontic treatment than did boys.
 Furthermore, mothers report...
PATIENT COMPLIANCE AND
ORTHODONTIC TREATMENT
 Patient psychology and compliance are important

factors in the treatment p...
 Compliance is not related to patient satisfaction in the

long run.
 Sex is a significant predictor for patient satisfa...
Effect of behavior modification on patient
compliance in orthodontics.
David Richeter et al , Angle Orthod 1998,68(2)
123-...
CONCLUSION
Old men can make war, but it is
children who will make history.

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REFERENCES
 Contemporary Of Orthodontics- William R Proffit.
 Textbook Of Pedodontics -- Shoba Tendon
 Essentials Of Pr...
 Shin-Jae Lee et al “ Patient compliance and locus of

control in orthodontic treatment: A prospective study”
Am J Orthod...
Tuhjse Naaraz nahi Zindagi..
Hairaan Hoon Main..bus hairaan
hoon main..!

THANK YOU
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CHILD PSYCHOLOGY /certified fixed orthodontic courses by Indian dental academy

  1. 1. CHILD PSYCHOLOGY www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Socha hi na tha ki jeene ke liye dard sambhalane honge.. Muskuraney ke liye dard bhulane honge.. Isi dard mein muskuraney ko log shayad kehte honge ZINDAGI…………! www.indiandentalacademy.com
  4. 4. CONTENTS            INTRODUCTION. DEFINITIONS. THEORIES OF CHILD PSYCHOLOGY. CLASSIFICATIONS. EMOTIONAL DEVELOPMENT. BEHAVIOR. PSYCHOLOGICAL MANAGEMENT MOTIVATION AND COOPERATION. PATIENT COMPLIANCE CONCLUSION. REFERENCES www.indiandentalacademy.com
  5. 5. WHY PSYCHOLOGY???  Psychological development is a dynamic process  Governed by genetic, familial, cultural, interpersonal & interpsychic factors  Dentist- “Parent Surrogate”  Need to understand psychological development to relate & guide effectively www.indiandentalacademy.com
  6. 6. Definitions  Psychology: The science of the human soul; specifically, the systematic or scientific knowledge of the powers and functions of the human soul, so far as they are known by consciousness; a treatise on the human soul.  Child psychology: The branch of psychology that studies the social and mental development of children - U.S. National Library of Medicine www.indiandentalacademy.com
  7. 7. Definitions…  Emotions: An effective state of consciousness in which joy, sorrow, fear, hate or the likes are expressed www.indiandentalacademy.com
  8. 8. Definitions…  Behavior- any change observed in functioning of organisms.  Behavior management- means by which dental team effectively and efficiently instills a positive dental attitude in child. -- Wright, 1975 www.indiandentalacademy.com
  9. 9. Importance of child psychology  Better understanding of the child  Know problems of psychological origin  Deliver dental service in a meaningful manner  Establish effective communication www.indiandentalacademy.com
  10. 10. Importance of child psychology  Gain confidence of child & parents  Better teaching of primary & preventive care  Effective treatment planning and execution  Provide a comfortable environment www.indiandentalacademy.com
  11. 11. Classification Theories of child psychology PSYCHODYANAMIC Psychosexual theory Psychosocial theory Cognitive theory BEHAVIOUR LEARNING Classical conditioning theory Operant conditioning theory Social learning theory Hierarchy of social needs MARGARET S MAHLER’S THEORY OF DEVELOPMENT www.indiandentalacademy.com
  12. 12.  Psychodynamic theories:  Psychosexual theory- Sigmund Freud (1905)  Cognitive development theory- Jean Piaget (1952)  Psychosocial theory- Eric Erickson (1963)  Behavioral theories:  Classical conditioning – Pavlov (1927)  Operant conditioning – Skinner (1938)  Hierarchy of needs – Masler (1954)  Social Learning theory – Bandura (1963) www.indiandentalacademy.com
  13. 13. Psychosexual/Psychoanalytical Theory Sigmund Freud (1905)  Attempts to explain the personality & psychological disorders .  Personality to originate from biological roots, as a result of satisfaction of set of instincts of which sexual instinct is important. www.indiandentalacademy.com
  14. 14. Psychosexual/Psychodynamic Theory • Described 6 stages– • oral anal urethral phallic latency genital At each stage sexual energy invested in particular part is called an erogenous zone. • Human mind– topographic model psychic model/psychic triad www.indiandentalacademy.com
  15. 15. Topographical model  MIND AS AN ICEBERG… Consists of….. ,,,,,,, conscious, preconscious & subconscious mind www.indiandentalacademy.com
  16. 16. Only 10% of an iceberg is visible (conscious) whereas the other 90% is beneath (unconscious) www.indiandentalacademy.com
  17. 17. Conscious mind  The conscious mind is where we are paying attention at the moment…  Only our current thinking processes and objects of attention  Constitutes a very large part of our current awareness www.indiandentalacademy.com
  18. 18. Preconscious mind  Ordinary memory & knowledge  Those things of which we are aware, but where we are not paying attention  Deliberately bring them into the conscious mind by focusing www.indiandentalacademy.com
  19. 19. Unconscious/Subconscious mind  The process and content are out of direct reach of the conscious mind.  Thinks and acts independently  Dump box for urges, feelings and ideas  Exert influence on our actions and our conscious awareness www.indiandentalacademy.com
  20. 20. www.indiandentalacademy.com
  21. 21. PSYCHIC TRIAD/MODEL SUPER EGO EGO ID www.indiandentalacademy.com
  22. 22. Structural mind  An individual’s feelings, thoughts, and behaviors are the result of the interaction of the id, the ego and the superego www.indiandentalacademy.com
  23. 23. ID – Pleasure principle  Basic structure of personality which serves as reservoir of instincts or mental representative.  Born with it.  As newborns, it allows us to get our basic needs met  Wants whatever feels good at the time, with no consideration for the reality of the situation  Strives for immediate pleasure and gratification www.indiandentalacademy.com
  24. 24. Ego  The rational part of the mind.  Develops out of ID in 2-6 month, when infant distinguish between itself and outside world.  Uses secondary processes (perception, recognition, judgment and memory)  Its governed by -- “Reality principle”  REALITY PRINCIPLE -- Developed after birth , expands with age and it delays modifies and controls ID impulses on realistic level. www.indiandentalacademy.com
  25. 25. Super ego  Prohibition learned from environment ( parents & society)  Acts as censor of acceptability of thoughts , feelings and behavior  Determined by regulations imposed upon child by parents , society and culture.  Its internalized control which produces feelings of shame and guilt. www.indiandentalacademy.com
  26. 26.  In a healthy person the ego is the strongest it can satisfy the needs of the id not upset the superego still take into consideration the reality of every situation www.indiandentalacademy.com
  27. 27. Ego defense mechanisms  These are tactics which the Ego develops to help deal with the ID and the Super Ego  All Defense Mechanisms share two common properties : - They often appear unconsciously. - They tend to distort, transform, or otherwise falsify reality www.indiandentalacademy.com
  28. 28. EGO DEFENCES ANXIETY When become overwhelming , EGO must defend itself. It does so consciously by blocking impulses EGO DEFENCE Distorting them in most acceptable manner MECHANISMS www.indiandentalacademy.com
  29. 29. Displacement:  Redirecting our impulses (often anger) from the real target (because that is too dangerous) to a safer but innocent person  Student scolded by teacher. shout at juniors stamping feet www.indiandentalacademy.com
  30. 30. Projection:  Attributing one's own unacceptable thoughts, feelings, impulses to others.  Person having aggressive feelings towards others may find it unacceptable to admit he/she have such feelings So they project as others have aggressive feelings towards him/her. www.indiandentalacademy.com
  31. 31. Reaction formation  Reversal of our feelings, overacting in the opposite way to the fear. Loose temper Laugh to prevent anxiety www.indiandentalacademy.com
  32. 32. Regression:  Giving up of mature problem-- solving methods in favor of child like approaches to fixing problems www.indiandentalacademy.com
  33. 33. REPRESSION PRIMARY REPRESSION PRIMAL REPRESSION Expulsion of thought and memories that might provoke anxiety from conscious mind Process by which hidden ID impulses are blocked from ever reaching consciousness. Past painful dental experience --- avoid thinking about painful event --repress anxiousness www.indiandentalacademy.com
  34. 34. Rationalization:  Giving excuses for shortcomings and thereby avoiding self-condemnation, disappointments, or criticism by others Poor performance in exam blame teacher www.indiandentalacademy.com
  35. 35. DENIAL  Person may deny(refuse) some aspect of reality. Big ulcer in mouth Diagnosed as carcinoma Not able to tackle, consult another doctor for denial of diagnosis. www.indiandentalacademy.com
  36. 36. Psychosexual Stages of Development  Failures to set satisfying needs/goals at any stages of psychosexual development leads to the individual partially fixed at these levels which are evident by various pathologic traits and in adulthood showing these signs in various forms. www.indiandentalacademy.com
  37. 37. Oral Stage (0 - 1.5 yrs )  Erogenous Zone in Focus: Mouth  Gratifying Activities: eating, sucking, gumming, biting & swallowing  The mother's breast not only is the source of food & drink, but also represents her love  Warm, trusting & affectionate relationship www.indiandentalacademy.com
  38. 38. Oral fixation  Both insufficient and forceful feeding can result in fixation in this stage  Symptoms of Oral Fixation:  Smoking  Constant chewing of pens, pencils  Nail biting  Overeating  Sarcasm ("the biting personality")  Attention seeking behavior  Aggressive, dominant www.indiandentalacademy.com
  39. 39. Anal Stage (1.5 – 3 yrs)  Erogenous Zone in Focus: Anus  Gratifying Activities: Bowel movement and the withholding of such movement  Toilet training  Discover their own ability to control  Child realizes his control over his needs and practices it with a sense of shame. www.indiandentalacademy.com
  40. 40. Anal Fixation Anal-Expulsive Personality If the parents are too lenient, the child will derive pleasure and success from the expulsion Are excessively sloppy, disorganized, reckless, careless, and defiant www.indiandentalacademy.com Anal-Retentive Personality If a child receives excessive pressure and punishment ,will experience anxiety over bowel movements Very careful, stingy, withholding, obstinate, meticulous
  41. 41. URETHRAL STAGE (3-4 yrs)  Transition between anal & phallic  Derives pleasure by exercising control over urinary sphincter  Objectives similar to anal stage  Loss of urethral control - shame www.indiandentalacademy.com
  42. 42. Phallic Stage(4-5 yrs)  Probably the most challenging stage in a person's psychosexual development  "Oedipus Complex" ( boy – mother )  "Electra Complex” ( girl – father )  Castration Anxiety  Penis envy  Consolidation of ego  Differentiating between sexes www.indiandentalacademy.com
  43. 43. Phallic Stage Objectives:  Child realizes the sexual qualities without embarrassment.  Resolution of the stage in regulation of drive impulse. Pathology: if above mentioned characters are not resolved the balance between male and female roles does not develop. www.indiandentalacademy.com
  44. 44. Latency Stage(6-12y)  Sexual feelings are suppressed to allow children to focus their energy on other aspects of life  Is a time of learning, adjusting to the social environment outside of home, absorbing the culture, forming beliefs and values www.indiandentalacademy.com
  45. 45. Latency Stage  Resolution of any defects  Maturation of ego  Greater control over instincts  Consolidation of sex roles  Mastery over skills  Phase ends in puberty  Lack of inner control – immature behaviour and decreased developmental skills. www.indiandentalacademy.com
  46. 46. Genital Stage (puberty onwards)  Erogenous Zone in Focus: Genital  Gratifying Activities: heterosexual relationships  Interaction with the Environment:  Marked by a renewed sexual interest and desire, and the pursuit of relationships.  Acceptance of adult role, Social expectations & values, mature personality. www.indiandentalacademy.com
  47. 47. Fixation  If people experience difficulties at this stage, and many people do, the damage was done in earlier oral, anal, and phallic stages .  Unresolved traits from previous phases seen in a modified form. www.indiandentalacademy.com
  48. 48. WHAT IS GOOD ABOUT THIS THEORY?  One of the first theories proposed in psychology  Stage wise classification help us to relate to patients well  Covers the psychological development of the entire lifespan  Role of biology and society have been highlighted  Concept of ego defenses was very practical www.indiandentalacademy.com
  49. 49. WHATS NOT SO GOOD ABOUT THIS THEORY?  Based only on the sexual drive  Based on studies conducted on few patients  Complicated and not very practically applicable  Has been a source of constant criticism and debate (sexuality, oedipus complex)  Most of the work based on psychological patients www.indiandentalacademy.com
  50. 50. PSYCHOSOCIAL THEORY: ERIK ERIKSON 1963  Infancy childhood old age  Development depends on child’s instincts and responses of those around him.  Unresolved issues from early stages of life affect person’s ability to deal with subsequent visits.  8 STAGES OF LIFE CYCLES : TURNING POINTS /PERIODS www.indiandentalacademy.com
  51. 51. PSYCHOLOGICAL CRISIS www.indiandentalacademy.com
  52. 52. 1. Basic trust Vs basic mistrust ( hope ) Birth- 18 months  First trust of INFANT MOTHER ( caregiver) Well handled adly handled Nurtured Loved Develops trust, security basic optimism. Becomes insecure And mistrustful. Maternal Deprivation ** SEPARATION ANXIETY- do the treatment in presence of parents. ** Dental team should gain confidence of child www.indiandentalacademy.com
  53. 53. 2. Autonomy Vs Shame( will ) 18 months- 3yrs  TODDLER begins to push for INDEPENDENCE  Terrible two’s.  Well parented child Sure of himself-autonomy  Failure to develop --- developments of doubt??????  "From a sense of self-control without a loss of self- esteem comes a lasting sense of good will and pride; from a sense of loss of self-control and foreign overcontrol come a lasting propensity for doubt and shame” -- ERIKSON www.indiandentalacademy.com
  54. 54. 3. Initiative Vs Guilt(purpose) 3-6 yrs  Child becomes more assertive ; resulting conflict cause GUILT . HEALTHY CHILD LEARNS  to broaden skills.  cooperative with others.  to lead as well as follow IF IMMOBILIZED BY GUILT  Fearful  depends always on adults  restricted play skills and imagination. Make first dental visit as new adventure.,,, if it fails lead sense of guilt in child www.indiandentalacademy.com
  55. 55. 4.Industry Vs Inferiority ( competence) 7-11 yr  Child learns basic culture skills – school skills  The child who, because of his successive and successful resolutions of earlier psychological factors is trusting, autonomous , initiative and enough to be industrious.  Orthodontic treatment often begins in this stage.  Cooperation – understanding of needs positively reinforce the needs.  Fails – mistrusting child- doubt the future. Shame and guilt filled child will experience defeat and inferiority. www.indiandentalacademy.com
  56. 56. 5. Identity Vs Role Confusion(Fidelity) 12-17 yrs  Child now is ADOLESCENT.  Learns how to answer satisfactorily and happily the questions WHO AM I????? WHAT SHALL I BECOME?????  Behavior management can be challenging in ADOLESCENT.  Orthodontic treatment in this stage carried out only he/she wants, not the parents at this stage. Approval of peer group is extremely important. www.indiandentalacademy.com
  57. 57. 6.Intimacy Vs Isolation( love)  The successful YOUNG ADULT.  Intimacy good marriage. friendship.  In this stage external appearance is very important.  Young adults may seek orthodontic treatment by internal motivation www.indiandentalacademy.com
  58. 58. 7.Generative Vs Stagnation(care)  In adulthood, the psychosocial crisis demands generatively, both in sense of marriage and parenthood.  Working productively and creatively. www.indiandentalacademy.com
  59. 59. 8.Integrity Vs Despair(Wisdom)  MATURE ADULT.  Peak of adjustments, integrity.  He/she trusts, independent and dares the new.  Works hard.  Finds well defined role in life.  Develops self concept which is happy. www.indiandentalacademy.com
  60. 60. PSYCHOSOCIAL THEORY MERITS  Age wise,, so easy to DEMERITS  Based on extreme ends apply to any stage.  Simple and comprehensive to understand. www.indiandentalacademy.com of personality.
  61. 61. COGNITIVE DEVELOPMENT THEORY- JEAN PIAGET (1952)  How children and adolescent think and acquire knowledge.  Derived from direct observation of children and questioning them.  Environment does not shape child behavior, but child and adult actively seek to understand the environment.  A child incorporates or assimilates events within the environment into mental categories called cognitive structures. www.indiandentalacademy.com
  62. 62. Adapt to new information Assimilation •Reinterpret new experiences so they EQUILIBRATION fit into old ideas. •Existing ideas don’t change, stay same Accommodation •Change old ideas so they can adapt to new. • Change current ways of thinking/ideas so as to add new knowledge ???????? Bird -- Flying object – Bee ?????? www.indiandentalacademy.com
  63. 63. Piaget’s Periods of Cognitive Development Birth to 2 years Sensori-motor Uses senses and motor skills, items known by use Object permanence learned TOY 2-6 yrs Pre-operational Symbolic thinking, language used; egocentric thinking Imagination/ experience grow, child de-centers RADIOGRAPH 7-11 yrs Concrete operational Logic applied, has objective/rational interpretations Conservation, numbers, ideas, classifications Formal operational Thinks abstractly, hypothetical ideas (broader issues) Ethics, politics, social/moral issues explored 12 yrs to adulthood Focus on organization and adaptation www.indiandentalacademy.com RETAINER ORTH TREAT
  64. 64. Cognitive development theory MERITS  Most comprehensive. DEMERITS  Underestimates ability.  Overestimates age differences in thinking. intellectual development.  Vagueness about change process.  Underestimates role of social environment.  Learn much about child’s www.indiandentalacademy.com
  65. 65. Classical conditioning – Pavlov (1927)  Russian psychologist Ivan Petrovich Pavlov – first to study conditioned reflexes experimentally.  Demonstrated how learned associations were formed by various events in an organisms environment.  Pavlov’s psychic reflex called as conditioned reflex by experiment. www.indiandentalacademy.com
  66. 66. Classic Ivan Pavlov experiment A simple three step example which shows the important elements of conditioning:  Step 1: Before conditioning Salivation – Unconditional response or unconditional reflex www.indiandentalacademy.com
  67. 67.  Step 2: The conditioning process Neutral stimulus Unconditional stimulus Note: Repetition of this is done at each time www.indiandentalacademy.com
  68. 68.  Step 3: After conditioning www.indiandentalacademy.com
  69. 69. How can we apply to Dentistry???....  First visit White coat (Neutral stimulus) Pain of injection (Unconditioned stimulus) pain of injection (Unconditioned stimulus) fear and crying (Response)  Second visit Sight of white coat (Conditioned stimulus) Pain of injection (Unconditioned stimulus) www.indiandentalacademy.com pain of injection (Unconditioned. Stimulus) fear and crying (Response)
  70. 70. Once conditioned response has established,, its necessary to reinforce it occasionally to maintain it. ACQUISATION -- GENERALIZATION -- EXTINCTION -- DISCRIMINATION www.indiandentalacademy.com
  71. 71. Operant Conditioning Theory  SKINNER B.F ( American psychologist)  Also called as Instrumental Learning.  Extension of classical conditioning.  Consequence of a behavior is in itself a stimulus that affects future behavior.  Behavior that controls or operates environment is called as OPERANT.  REINFORCEMENT is critical factor in learning and development of www.indiandentalacademy.com personality.
  72. 72.  Four basic types of operant conditioning: (distinguished by the nature of the consequence.): 1. Positive reinforcement 2. Negative reinforcement 3. Omission 4. Punishment www.indiandentalacademy.com
  73. 73. : Positive reinforcement A pleasant consequence follows a response. A child is given a reward such as a toy for behaving well during her first dental visit. www.indiandentalacademy.com
  74. 74. Negative reinforcement  Involves the withdrawal of an unpleasant stimulus after a response.  Leads to the removal of an undesirable stimulus. Temper tantrum   Child Go to clinic. If this behavior (response) succeeds -- likely to occur the next time a visit to the clinic is proposed.  So in dental office, it is important to reinforce only desired behavior. www.indiandentalacademy.com
  75. 75. Omission (also called time-out):  Involves removal of a pleasant stimulus after a particular response.  Favorite toy taken away for a short time (sending the mother out of the operatory) as a consequence of this behavior, the probability of similar misbehavior is decreased. www.indiandentalacademy.com
  76. 76. Punishment:  Occurs when an unpleasant stimulus is presented after a response. This also decreases the probability that the behavior . Effective at all ages, not just with children. Firm voice – voice control. Use of tongue crib for correction of tongue thrusting habit. www.indiandentalacademy.com
  77. 77. Social Learning Theory  Albert Bandura  Emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others.  Social learning theory explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, an environmental influences. www.indiandentalacademy.com
  78. 78.  General principles of social learning theory are as follows: 1. People can learn by observing the behavior of others and the outcomes of those behaviors. 2. Learning can occur without a change in behavior. 3. Cognition plays a role in learning. 4. Social learning theory can be considered a bridge or a transition between behaviorist learning theories and cognitive learning theories. www.indiandentalacademy.com
  79. 79.  Observational learning is also known as Imitation or Modeling.  Learning occurs when individuals observes and imitate others’ behavior.  There are four component processes influenced by the observer’s behavior following exposure to models.  Attention  Retention  Motor Reproduction  Motivation. www.indiandentalacademy.com
  80. 80. EFFECTS OF MODELING ON BEHAVIOR  Modeling teaches new behaviors.  Modeling influences the frequency of previously learned behaviors.  Modeling may encourage previously forbidden behaviors.  Modeling increases the frequency of similar behaviors. www.indiandentalacademy.com
  81. 81. Hierarchy Of Needs  Maslow believed in self-actualization theory.  Based on totality of personality development.  But its difficult and impractical to apply to children and dental situation. www.indiandentalacademy.com
  82. 82. Hierarchy Of Needs- 1954  Abraham Harold Maslow To achieve one’s full potential To be competent and recognized To love and to be loved, to have friends Security, comfort, freedom from fear Food , water and oxygen www.indiandentalacademy.com
  83. 83. Emotional development  EMOTION is a state of mental excitement characterized by physiological, behavioral changes and alterations of feelings Characteristics of commonly seen emotions in child  CRY  ANGER  FEAR  ANXIETY  PHOBIA www.indiandentalacademy.com
  84. 84. CRY:  Elsbach 1963 TYPES  Obstinate cry  Frightened cry  Hurt cry  Compensatory cry www.indiandentalacademy.com
  85. 85. OBSTINATE CRY  Temper tantrum  Loud, High-pitched, Siren-like  Form of emotionally aggressive behavior  External response to anxiety FRIGHTENED CRY  Torrent of tears  Convulsive breath-catching sobs  Situationally Over-whelmed www.indiandentalacademy.com
  86. 86. HURT CRY  May be loud or a small whimper  Single tear – First indicator  Most easily recognized as the child acknowledges it. COMPENSATORY CRY  More sound & less cry..!  Droning monotonous coping resort  More strategic and less anxiety related  Few actual tears..if any.. www.indiandentalacademy.com
  87. 87. ANGER: Outburst of emotion caused by child’s lack of skill in handling situation. ANXIETY: Its emotion similar to fear but arising without any objective source of danger.(Its reaction to unknown danger) FEAR: Fear is reaction to known danger , its source is consciousness. PHOBIA: it’s a persistent , excessive ,unreasonable fear of a specific object, activity or situation . www.indiandentalacademy.com
  88. 88. Behavior: any change observed in functioning of an organism. Frankel’s classification(1962): 1. Def –ve (- -) : refuses, cries, associated with fear 2. – ve (-) : reluctant and slight negativism 3. + ve (+) : accepts, bad experience – uncooperative 4. Def +ve (+ +): unique , looks forward, understands importance of treatment www.indiandentalacademy.com
  89. 89. Reaction to the first dental visit  Major Hurdles..  Fear of separation  Maternal Anxiety  Child’s dental awareness  Negative portrayal of dentistry  Age - Poor cognitive ability  Low socioeconomic status www.indiandentalacademy.com
  90. 90. PSYCHOLOGICAL MANAGEMENT  Orthodontic treatment initiated during pre-pubertal or early pubertal developmental period of child.  Initial exam and consultation diagnosis and treatment plan discussed with child and parents.  If extractions are planned, its important to present possibility of extractions to the patient during initial examination or early treatment planning. Norton et al “Psychological management of young orthodontic patient”. Angle orthodontist july 1971 www.indiandentalacademy.com
  91. 91. PSYCHOLOGICAL MANAGEMENT OF PATIENT BY SPECIFIC AGE GROUPS 1. YOUNG CHILD FROM 6-9YRS  Attempt to break infantile habits of digit sucking and tongue thrusting.  Fixed appliances www.indiandentalacademy.com
  92. 92. 2. EARLY ADOLESCENT ( 10-13 YRS)  Sexual differences become more important in girl child.  A boy will look for male identification.  Develops interests in sports.  To gain co-operation from child one must show interest in his interests. www.indiandentalacademy.com
  93. 93.  Explain each treatment procedure.  If you show care for young patient , he will care for you being co-operative.  Female child of 10-13yrs quite different from boys.  She is giggly, silly, extremely vain and passionately interested in her developing body. www.indiandentalacademy.com
  94. 94.  Some times it may end up with CRUSH SYNDROME– which is difficult management problem.  This behavior must be discouraged, but bluntness will hurt child psychologically.  Substitute reality for fantasy, remain cordial and friendly talk about real world www.indiandentalacademy.com
  95. 95. 3. TEENAGER( 14-18YRS)  Teenage male wishes to be treated as adult.  Management of teenage male is a matter of sympathy and understanding.  Teenage female has same psychic development but different expressions.  She is body, peer and sex conscious also, she wants to be well developed as her peers. www.indiandentalacademy.com
  96. 96. MOTIVATION AND CO-OPERATION  Patient cooperation is an essential factor in the timely, successful outcome of orthodontic treatment.  Parents of orthodontic treatment undergoing child more motivated than parents of those children are not yet in treatment Daniels et al Orthodontic treatment motivation and cooperation: A cross-sectional analysis of adolescent patients’ and parents’ responses. , Am J Orthod Dentofacial Orthop 2009;136:780-7) www.indiandentalacademy.com
  97. 97.  Girls reported greater willingness to cooperate with orthodontic treatment than did boys.  Furthermore, mothers reported that their children would be more cooperative with treatment than did the fathers.  Mothers were also more motivated for their child to have braces than were fathers. www.indiandentalacademy.com
  98. 98. PATIENT COMPLIANCE AND ORTHODONTIC TREATMENT  Patient psychology and compliance are important factors in the treatment protocol. Patient compliance appears to be a complex issue that cannot easily be predicted before treatment .  There is an incidental psychological gain through orthodontic treatment.  Shin-Jae Lee et al “ Patient compliance and locus of control in orthodontic treatment: A prospective study” Am J Orthod Dentofacial Orthop 2008;133:354-8) www.indiandentalacademy.com
  99. 99.  Compliance is not related to patient satisfaction in the long run.  Sex is a significant predictor for patient satisfaction regarding the doctor-patient relationship and the situational aspects of the treatment.  Treatment time for female subjects would be longer than for male subjects, even though actual treatment time showed no differences.  Annemieke bos et al Patient compliance: A determinant of patient satisfaction? Angle orthod 2005; 75:526–531 www.indiandentalacademy.com
  100. 100. Effect of behavior modification on patient compliance in orthodontics. David Richeter et al , Angle Orthod 1998,68(2) 123-132  Study the effects of reward system for improving patient compliance.  Above average compliance group remained unchanged.  Below average improved with rewards , however never reached above average.  Age and sex – no influence. www.indiandentalacademy.com
  101. 101. CONCLUSION Old men can make war, but it is children who will make history. www.indiandentalacademy.com
  102. 102. REFERENCES  Contemporary Of Orthodontics- William R Proffit.  Textbook Of Pedodontics -- Shoba Tendon  Essentials Of Preventive And Community Dentistry – Soben Peter  Norton et al “Psychological management of young orthodontic patient”. Angle orthodontist july 1971  Daniels et al Orthodontic treatment motivation and cooperation: A cross-sectional analysis of adolescent patients’ and parents’ responses. , Am J Orthod Dentofacial Orthop 2009;136:780-7) www.indiandentalacademy.com
  103. 103.  Shin-Jae Lee et al “ Patient compliance and locus of control in orthodontic treatment: A prospective study” Am J Orthod Dentofacial Orthop 2008;133:354-8)  Annemieke bos et al Patient compliance: A determinant of patient satisfaction? Angle orthod 2005; 75:526–531  David Richeter et al Effect of behavior modification on patient compliance in orthodontics. Angle Orthod 1998,68(2) 123-132 www.indiandentalacademy.com
  104. 104. Tuhjse Naaraz nahi Zindagi.. Hairaan Hoon Main..bus hairaan hoon main..! THANK YOU www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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