This seminar consists of an introduction to child psychology followed by psychodynamic theories and its applicatioms followed by description and types of fear and anxietry followed by various behaviour rating scales and classification of behaviour

1. APPLIED CHILD PSYCHOLOGY –
THEORIES OF CHILD
PSYCHOLOGY,FEAR,
ANXIETY,AND CLASSIFICATION
OF BEHAVIOR
Karishma.S
III MDS

2. CONTENTS:
• Introduction
• Importance of child psychology
• Theories of child psychology
 psychoanalytical
 Psychosocial
 Cognitive
• Fear
• Anxiety
• Classification of behaviour
• References
• conclusion

3. INTRODUCTION
 The developmental changes that occur from birth to adulthood through
adolescence were largely ignored in the past. Children were often
viewed simply as minor versions of adults and little attention was paid to
their abilities.
 Intrest in the field of child development began early in the 20th century.
 Psychological development is a dynamic process which begins at birth
and proceeds in an ascending order through a series of sequential stages
manifesting in various characteristic behaviours.These stages are
governed by genetic, familial, cultural. Interpersonal and interpsychic
factors.

4. • Psychology --- It is the scientific study of the human mind and its
functions, especially those affecting behaviour in a given context.
• Child psychology --- science that deals with the mental power or an
interaction between the conscious and subconscious element in a
child
• Emotion --- A feeling or mood manifesting into motor and glandular
activity.

5. Importance of studying child psychology
(quintessence int.2001; 135p) (JDC 1974;35p)
Provides information about:
 Child's behavior and psychological growth
 Psychological scales for appraising a child’s developmental status
 Certain norms of behavior and growth for comparative purposes
 Understanding of basic psychological processes like learning, motivation, maturation
and socialization
 New trends and fads in child care & training
 Guides psychological growth of children who experience difficulty in adjusting
to others.

6. In Dentistry
(quintessence int.2001; 135p) (JDC 1974;35p)
• To understand the child & know his problem
• To deliver treatment effectively
• To establish effective communication with child and parents
• To gain confidence of child and parents
• To teach and motivate them about importance of primary and
preventive care
• To plan out effective treatment
• To provide comfortable and satisfactory treatment

7. Theories proposed on Child Psychology
Psychodynamic theories
- Psychosexual theory --- Freud -1905
- Psychosocial theory ---Eric Erikson1963
- Cognitive theory ---Piaget - 1952
Behavioral theories
- Classical conditioning --- Pavlov - 1927
- Operant conditioning --- Skinner - 1938
- Hierarchy of needs --- Maslow - 1963
- Social learning theory --- Bandura – 1954
Miscellaneous theories
- Separation & individualization --- M Mahler
- Attachment theory --- J Bowlby
- Information processing

8. Psychoanalytical/ Psychosexual theory
--- Freud -1905
 Sigmund Freud
 Personality to originate from biological roots as a result of satisfaction of a
set of instincts of which sexual instinct was the most important.
 He described 5 psycho-sexual stages, at each stage sexual energy is invested
in a particular part called as erogenous zone.
 He described human mind with the help of two models:
 Topographic model
 Psychic model/psychic triad

9. TOPOGRAPHIC MODEL
 Compared to an iceberg
Conscious - Small part above surface of
water – our current awarenessSubconscious – all information not currently
on mind, but can bring into conscious if
called upon.
Unconscious – below surface – store house
of impulses, wishes or inaccessible memories
that affect our thoughts & behavior

10. PSYCHIC MODEL/PSYCHIC TRIAD
Composed of three parts:
 ID – Pleasure principle
 EGO – Reality principle
 SUPER EGO - Moral

11. • Most primitive part & from which ego & superego develops
• Present in newborn & most basic biological drives (eat, drink,
eliminate wastes)
• Aggression is also a basic biologic drive
• Seeks immediate gratification of the impulses
• Operates on Pleasure principle – strives to obtain pleasure &
to avoid pain, regardless of external circumstances
• 2 methods to relieve tension caused by Id impulses
• Reflex action → simple response occurring reflexively to stimulus
(hunger) – sucking of nipple
• Primary process thinking → creation of fantasy about object to
reduce tension
ID

12. • Develops out of ID in the 2nd to 6th month of life
• Children soon learn that impulses cannot be gratified
immediately
• Operates on Reality principle – gratification of impulse is
delayed until situation is appropriate
• Secondary process thinking or realistic thinking
• Finds way to satisfy those drives.
• Mediates between id, realities of world & demands of super
ego
EGO

13. • It is a prohibition learned from environment, Judges if
actions are right or wrong
• It acts as a censor of acceptibility of thoughts, feelings and
behavior.
• Internalized representation of the values & morals of society
• 2 subparts – conscience & ego ideal
• The ego ideal is the idealistic view of what is right, while the
conscience is that sense of guilt, or the view of what is
considered wrong.
• Develops in response to parental rewards or punishments
SUPER EGO

14. EGO DEFENSE MECHANISM:
The ego deals with the demands of reality, the id and the superego as best as
it can. But when the anxiety becomes overwhelming, the ego must defend
itself.
It does so by un-consciously blocking the impulses or distorting them into a
more acceptable less threatening form.
These techniques are known as the ego defense mechanisms.

15. • Identification – This is incorporating an external object(another person) into ones
own personality, think act and feel like someone else.
Ex:Identifies himself as his elder brother whom is often praised by the dentist
for his good behavior
• Displacement – Transfer of desires or impulses onto a substitute person/object.
Show the anger on his mother by hitting her or scolding her when she comes out
• Sublimation – Chanelling of unacceptable impulses or emotions into socially
acceptable behavior.
• Repression – tries to take away the unpleasant memories or anxiety he has towards
the dental treatment, from his conscious awareness.
• Primary repression
• Primal repression
• Denial – Simply denies the fact that he has anxiety
towards treatment

16. • Projection – This is where characteristics that are unacceptable to a persons ego are
projected into someone else.
Ex: I am good but “it is the dentist who is bad”
• Reaction formation – This is where a person displays behavior that is the exact
opposite of an impulse that he/she dare not express or acknowledge.
• Ex: when you are not able to control your temper, you start laughing to prevent
anxiety.
• Rationalization – Attempt to express our behavior to ourselves and others in ways
that are seen as rational and socially acceptable
Ex: The treatment is good but it will be of no help to me
• Intellectualization – Defense mechanism by which reasoning is used to block
confrontation.
Ex: Tooth with germs is not mine so let the dentist do what ever he wants

17. Sigmund freuds stages of development

18. THE ORAL STAGE (0 - 1½ Y) :
 Birth – 18 months.
 Introduction: In infants the oral cavity is the site for identifying needs,
it therefore serves as an erogenous zone.
 Characteristic: This is a dependent stage since the infant is dependent
on adults for getting his oral needs fulfilled
 Objectives: Satisfaction of oral desires eg: suckling of milk, help in
development of trust
 Pathology: If child’s needs are not adequately met in this stage the
following traits develop: - Excessive optimism, narcissm, pessimism,
demanding ness, envy, jealousy

19.  Introduction: - maturation of neuromuscular control occurs. - control over
sphincters particularly anal sphincter results in increased voluntary activity.
 Characteristics: development of personal autonomy & independence. Child
realizes his control over his needs & practices it with a sense of shame or self
doubt
 Objective: The child realizes the increasing voluntary control ,which
provides him with the sense of independence & autonomy.
 Pathology: It is characterized by various abnormal behaviors like:
disorderliness, abstinence, stubbornness, willfulness, fragility.
Anal stage (18 months - 3 years)

20. URETHRAL STAGE:
 It is a transition between the anal stage & phallic stage.
 The child derives pleasure from exercising his control over the
urinary sphincter.
 Loss of urethra control result in shame.
 Competitiveness

21. THE PHALLIC STAGE (3-6Y) :
 The most intricate of the stages; erogenous zone shifts from the anus to the
genitals.
 Males have the potential to develop an Oedipal Complex, while females may
develop an Electra Complex.
 The child realizes the sexual qualities without embarrassment.
 If the above mentioned characterisics are not resolved the balance between
male and female roles does not develop.

22. OEDIPUS COMPLEX :
- A boy’s feelings for his mother and rivalries with his father
- Psychological defenses develop against these threatening
thoughts and feelings
- Tries to imitate father to impress mother
ELECTRA COMPLEX:
-Young girls develop attraction towards father
- A girl develops feelings of inferiority and jealousy of
mother being close to the father

23. Penis envy:
The girl notices that she does not have the sexual organs of her father
or brothers. She suspects that she may actually have been castrated
by her mother; this makes her angry, and she comes to resent and
devalue her mother
CASTRATION ANXIETY:
- Unconscious fear of loss of genitals
- Fear of punishment from the father for their desire for the mothers.

24. THE LATENCY STAGE (8-13Y) :
 Transitioning period between the Phallic and Genital stages.
 Resolution of any defects occur in this phase and the phase ends in puberty
 Maturation of ego takes place and Child develops better sense of initiative and
starts adapting to the adverse environment
 Focuses on areas like academics and athletics, etc. Same-sex friendships develop
during this time.
 The goal of this phase is the further development of personality
 Lack of inner control or excessive inner control results in a pathological trait
 Lack results in an immature behavior and decreased developmental skills

25. THE GENITAL STAGE ( 11-13Y) :
 Primary objectives are ultimate separation from dependence &
establishment of mature relations.
 Child makes contact and form relationships with members of opposite
sex
 SUPEREGO undergoes further development and become more flexible
 Matures the personality of the individual
 Their acceptance of adult role functions with social expectations and
cultural values.
 Unresolved traits from the before
stage are seen in a modified form.

26. Merits of Freud’s theory:
One of the earliest and the most comprehensive theories of life long
psychological development.
Demerits:
Freud formulated this theory by his extensive studies on adult
psychological patients and hence its explanation to children is not
very justified.
This theory is based on observations of the psychologist.

27. Psychosocial theory- Eric H. Erikson
Erickson concentrated on child’s development covering
the entire span of life cycle from infancy to childhood through old age.
Unlike Freud, Erickson emphasized the conscious self as much as unconscious
instincts. Despite differences, Freud and Erickson
share some important assumptions.
 Development depends upon child’s instincts and responses of those around him.
 Unresolved issues from early stages of life affect person’s ability to deal with
subsequent stages.

28. Erickson described 8 stages of life cycle which are marked by internal
crises defined as the turning points /periods.

29. Basic trust Vs Mistrust (Oral) – Birth – 1 year
• Infants depend on parents or caretakers for food, warmth & affection
• demands are met - Trust in world; people around them as helpful
• care is inconsistent, inadequate or rejecting – Mistrust; “Fear of
abandonment’’ & suspicion
• Dental consideration
• Tight bond between parent & child – “separation anxiety”
• Treatment to be done in parent’s presence/parents holding.
• Later stages, there is difficulty in entering situations that requires
confidence & trust in another person - uncooperative

30. Autonomy Vs Shame (will) – 1 – 3 years
• “Terrible 2’s” – uncooperative & obnoxious behavior
• Varies between little Devil or Angel
• Parents provide opportunities to develop independent behavior; protect against
consequences of dangerous & unacceptable behavior – sense of Autonomy or
independence
• Failure to support or encourage – Doubt about his ability to stand alone & about
others / shame.
• Dental consideration
• Child should think whatever the dentist does is of his/her own choice – offer
reasonable choices
• Parental presence is needed

31. III. Initiative Vs Guilt (Phallic) – 3 – 6 years
• Continues to develop greater autonomy – planning of activities
• Shown by physical activity, extreme curiosity & questioning
• Major task to channelize into manageable tasks (tasks which child can succeed)
• Eager modeling of behavior of whom he respects
• Succeed with task (initiative) Vs not successful (Guilt)
• Fear of bodily injury

32. Dental consideration
 Going to dentist can be constructed as a new &
challenging adventure – child can experience success
 success in coping with anxiety – develops independence
 First visit – exploratory, non invasive procedures &
parent presence
 subsequent visit – in absence of parents

33. IV. Industry Vs Inferiority (Latency) – 6 – 11 years
• Child works to acquire academic & social skill (industriousness)
• Competition with others within reward system - reality
• The child who is trusting, autonomous and full of initiative will learn easily
enough to be industrious.
• Mistrusting child will doubt the future
• Not successful, shame and guilt filled child (Inferiority)
• Fear of Superego anxiety

34. Dental consideration:
 Influenced by peer groups
 Behavior guidance – modeling, positive reinforcement
 No use of abstracts – “If you wear this appliance, your bite will
be better”
Rather “Your teeth will look good if you wear this appliance”

35. V. Identity Vs Role confusion (Genital) – 12 – 18 years
• Period of intense physical development
• Sense of belonging to larger group & realization of surviving outside family
• Complex stage – relationships with others, academic responsibilities, physical
changes & career possibilities
• Increased influence by peer groups
• Separation from peer group – establish one’s own uniqueness & values (Identity)
• Inability to separate – failure of identity development (Identity confusion – low
self-esteem)

36. Dental consideration:
 Parental authority is rejected
 Any treatment instituted only if patient wants & not if
parents want (treatment as something done for & not to
them)
 Abstract concepts can be grasped; motivation to wear
appliances

37. VI. Intimacy Vs Isolation - Emerging adulthood
• Attainment of intimate relationship with others
• Successful development of intimacy – willingness to compromise & sacrifice
• Failure – isolation from others
• Dental consideration
• Orthodontic treatment
• New appearance – facilitate attainment of intimate relationship or interfere with
previously established relationships

38. VII. Generativity Vs Stagnation - Adulthood
• Generativity means giving to next generation through child rearing, caring for
others or productive work
• Stagnation – absence of meaningful accomplishment - self-indulgence & self-
centered behavior
VIII. Integrity Vs Despair – Old age
• Integrity - Feeling that one has made the best of the life’s situation & has made
peace with it
• Despair – expressed as disgust & unhappiness, frequently accompanied by fear
of death

39. MERITS:
 Classification is based on age of an individual, hence easy
to apply at any stage of development
 Simple and comprehensive to understand
DEMERITS:
 Based on extreme ends of personality

40. Piaget formulated his theory on how children and adolescents think and acquire
knowledge. He derived his theories from direct observation of children by
questioning them about their thinking.
According to Piaget, the environment does not shape child behavior but the child
and adult actively seek to understand the environment. This process of adaptation is
made up of 3 functional variants :
 Assimilation
 Accomadation
 Equilibration
COGNITIVE THEORY – JEAN PIAGET

41. Assimilation: Concerns with observing, recognizing, taking up an
object and relating it with earlier experiences or categories.
Accommodation: Accounts for changing concepts and strategies as
a result of new assimilated information.
Piaget calls the strategies and mental categories as "schemas’.
Equilibration: Refers to changing basic assumptions following
adjustments in assimilated knowledge so that the facts fit better.

42. A schema is a cognitive framework or concept that helps organize and
interpret information. Schemas can be useful because they allow us to take
shortcuts in interpreting the vast amount of information that is available in
our environment.

43. The sequence of development has been categorized into 4 major stages :
1) Sensorimotor stage (0 to 2 yrs)
2) Pre-operational stage (2 to 6 yrs)
3) Concrete operation stage (6 to 12 yrs)
4) Formal operation stage (11 to 15 yrs)

44. Sensorimotor stage - 0-2yrs
 Develops rudimentary concepts of objects
 Objects in the environment are permanent; do not
disappear when the child is not looking at them.
 Communication between a child at this stage and an adult is extremely
limited because of the child’s simple concepts and lack of language
capabilities.
 Little ability to interpret sensory data and a limited ability to project
forward or backward in time.

45. Preoperational stage - 2-7yrs
 Good language development
 Capacity to form mental symbols – represent things and events
 Children learn to use words to symbolize the objects.
 Understand the world in the way they sense it through its
primary senses: sense of vision, earing, smell, taste or feel
 Child learns to classify things
 Solves problem, but cannot explain how it solved

46.  Egocentrism -- child is incapable of assuming another person’s
point of view.
 Animism -- investing inanimate objects with life.
Animism can be used to the dental team’s advantage by giving
dental instruments and equipment life –like names and qualities.
 Constructivism – child acquires reality by touching, exploring,
observing
CHARCTERISTICS OF PREOPERATIONAL PERIOD

47. Stage of concrete operations - 7-11yrs
• Good answering / reasoning capacity
• Decline of egocentrism
• Decline of animism
• Thinks much more like adults
• Easy to treat

48.  Conservation of Length
 Conservation of Liquids
CONSERVATION :
 Conservation of area
A)
A)
B)
B)
B)
A)
logical thinking ability that allows a person to determine that a certain quantity
will remain the same despite adjustment of the container, shape, or apparent
size

49. Seriation

50. Period of formal operations - 11yrs & above
• Good communication skill
• Child is a teenager & should be treated as adult
• Concept of imaginary audience – constantly on stage
• Capable of understanding concepts like health diseases and
preventive treatment.
• The child can reason a hypothetical problem and do a
systematic search for solution.
• Dental applications include esthetic and corrective dental
treatment.

51. MERITS:
 Most comprehensive theory of cognitive development.
 This theory propagated that we can learn as much about childrens
intellectual development fron examining their incorrect answers.
DE-MERITS:
 Underestimates chidrens abilities
 Under estimates the role of the social environment.
 Vagueness about the process of change.
 Overestimates age differences in thinking.

52. Fear is a reaction to a known danger (Its source is the consciousness). It may be
defined as an unpleasant emotion or effect consisting of psycho-physiological
changes in response to realistic threat or danger to one’s own experience.
Prevalence of Fear:
• Various studies have found the incidence of dental fear
to be 3-21%, depending on the age of the child.
• Girls have been reported to have more fears than boys.
FEAR:

53. Several reasons are suggested
At the same time, the type of fear varies at different ages such as:
Development of fear
a. At birth:
This is a primary response acquired soon after birth such as a startle response,
however, the newborn is unaware of the stimulus.
With age he starts becoming aware of fear producing stimuli and can adjust to
the experience by resorting to flight if he cannot solve the problem.
Sometimes, the smells and sounds of equipment or even the appearance of
dentist with glasses and mask may be frightening.

54. b. Pre schooler( 2-5years)
• Fear of animals or being left alone or abandoned.
• More apprehensive about failures, learns to fear his prestige.
c. Early schooler
Fear of the dark, staying alone. Shows fear of supernatural powers like ghosts and
witches, imaginary objects and situations such as fear
of war, spies , beggars, etc.
d. Late schooler
• By age of 9, fear of bodily injury may be present.
• Fear of failure, not being liked, competition,
• fear of punishment.
• Fear of crowds, heights.
e. Adolescent
Fear of social rejection and fear of performance ( peer group pressures, academic
pursuits).

55. It is observed that fearful patients usually report a history of traumatic dental experiences.
Unfavorable family attitudes may also result in fear.
Thus, various types of fears can be observed in the clinic as:
I Innate fear (without stimuli or previous experience):
It is thus also dependent on the vulnerability of the individual.
II Subjective fear: Fears transmitted to the individual. They may be due to:
Family experiences, peer (friends), information media (TV, papers, comics).
Fear of Dental Situation

56. III Objective fear: Fears due to events, objects and specific
conditioning. Previous experience (dental trauma) or generalization
(medical experience).
Fear Evoking Dental Stimuli
 Extraction.
 Sound of drill.
 Anaesthetic administration locally by injection.
Factors Causing Dental Fear
An interaction of various factors occurs in the existence of dental fear such.as:
1. Fear of pain or its anticipation.
2. A lack of trust or fear of betrayal .
3. Fear of loss of control.
4. Fear of the unknown .
5. Fear of intrusion

57. Fear is a package of reactions that tend to occur together simultaneously or
sequentially.
About 70% children acquire dental fear at early age. This emotion may
present the following main two expressions:
1. Tendency to freeze which reaches its extreme in the form of death.
2. Startle, scream, run away from the scene of danger, i.e. flight .
It turns, a shift from freeze reaction to flight
FEATURES OF FEAR

58. Physiological Sign of Fear
• Pale sweaty skin.
• Hair standing on end
• Dilatation of pupils.
• Rapid breathing.
• Increased heart-rate,
• Rising blood pressure,
• Increased blood flow through muscles.
• Contraction of the bladder and the rectum
Biochemical Changes in Few Minutes
• Secretion of adrenaline.
• Secretion of noradrenaline.
• Increase in free fatty and corticosteroids in plasma.

59. It can be described at three level:
1. Intellectual level: Where the child is ready to accept the situation and face the
difficulties to achieve results and benefits (usually seen at adolescent age).
2. Emotional level: Usually the child shows the fight or flight response, which acts as
an instantaneous response (seen in school age).
3. Hedonic level: Usually reflected as self centeredness, thereby accepting what is
comfortable and rejecting what is not without too much concern for the outcome or
nature of the treatment ( may be seen in a very young children). It may be expressed
through somatic complains or chronic fatigue in the elderly group
RESPONSE TO FEAR:

60. Value of fear
• Fear lowers the threshold of pain so that every pain produced during
dental treatment becomes magnified.
• Fear has safety value when given proper directions and control, It is a
protective mechanism for self – protection.
• The nature of fear can be utilized to keep the child away from dangerous
situation of either social or physical nature.
• If the child does not fear punishment or parental disfavor, his behavior
may make him a threat to the society.
• The child should be taught that dental office is not a place to fear.
Dentistry should not be employed as a threat or punishment.

61.  Is an emotion similar to fear but arising without any objective
source of danger.
 Is a reaction to unknown danger.
 It is often been defined as a state of unpleasant feeling combined
with an associated feeling of impending danger from within rather
than from without .
 It is a learned process being in response to one 's environment.
 As anxiety depends on the ability to imagine, it develops later than
fear.
Anxiety

62. Attribution
Anxiety arousal in the biological sphere.
Appraisal
Here anxiety is concerned with cognition or the way we think . It involves
reconstruction of negative experiences rather than positive happenings
that account for the arousal of anxiety.
Cause of Anxiety
• Uncertainity
• Previous learning
• Biological difference
Sub-types of anxiety
Association
This is a process of classic conditioning whereby previously neutral
stimuli become the cause for arousal and anxiety by pairing them with
pain or the negative experiences of others.

63.  Trait anxiety:
Is a lifelong pattern of anxiety as a temperament feature. These children are
generally jittery, skittish, hypersensitive to stimuli.
 State anxiety:
Are acute situationally bound episodes of anxiety that do not persist beyond the
provoking situation.
 Free floating anxiety:
A condition of persistently anxious mood in which the cause of emotion is
unknown and many other thoughts or events trigger the anxiety.
Types of Anxiety

64.  General anxiety:
Where the individual experiences a chronic pervasive feeling of
anxiousness whatever are the external circumstances.
 Situational anxiety:
Seen only to specific situations or objects.

65. Anxiety Rating Scale
The patient 's anxiety can be evaluated through the following scales:
Pictorial and Response Card:
The scale evaluates the child ’s fear in the dental set-up in different situations such as:
- appointment with the dentist
- waiting for his turn in the dentist’s office
- dental procedures
- lying on bed dreaming about the dentist, etc.

66. Verbal Questions
• The child is asked questions or given in sentence completion tasks”
to verbalize his fear.
• Negative or reluctant answers imply fear while positive opinions imply non-
fearful child
Questionnaire
Anxiety can also be evaluated by answers to the questionnaire given to the child
patient and the parent. The questions help to determine the attitude and experiences
of both the patient and parent.

67. CLASSIFICATION OF BEHAVIOR:
Behaviour: is an observable act, which can be described in similar ways by
more than one person. It is defined as any change observed in the functioning
of an organism. Learning as related to behavior is a process in which past
experience or practice results in relatively permanent changes in an individual’s
behaviour.
Behavioural science: is the science which deals with the observation of
behavioural habits of man and lower animals in various physical and social
environment including behaviour pedodontics, psychology, sociology and social
anthropology.
Behavioural Pedodontics: It is a study of science which helps to understand
development of fear, anxiety and anger as it applies to child in the dental
situations

68. Classification of child’s behaviour observed in
dental clinic
Various behavioue evaluation scales:
 Wilson – 1933
 Frankl – 1962
 Visual analogue scale - 1970
 Lampshire – 1970
 Nazif – 1971
 Wright – 1975
 Melamed et al – 1978
 Gracia-godoy - 1986
 Venham et al – 1990
 Machen and jhonson – 1991
 Facial imaging scale
 Modified child dental anxiety scale.

71. A Review of Behavior Evaluation Scales in Pediatric Dentistry and Suggested
Modification to the Frankl Scale
Hicham Riba1*, Saleha Al-Zahrani2, Noura Al-Buqmi2 and Azzam Al-Jundi1, December 30, 2017
Aim: The purpose of this paper is to review and stress the importance of different behavior evaluation
scales used in pediatric dentistry with more emphasis on the widely used Frankl scale, and to suggest a
modification to the latter to clarify the gray area between the positive and negative ratings.
Background: Anxiety associated with dental procedures can be reflected on the child’s behavior.
Therefore, it is important for pediatric dentists to be able to assess and evaluate psychological,
personal traits and behavioral responses of the child in order to identify the need for modifications in
the management approaches to reduce dental anxiety
Review Results: This paper reviews the current literature concerning behavior evaluation scales used
in pediatric dentistry. It includes MEDLINE database search and review of the comprehensive
textbooks in pediatric dentistry. Some recommendations were based on the opinions of experienced
researchers and clinicians.
Conclusions: The Frankl behavior scale, along with other scales, is highly useful in pediatric dentistry to
assess the level of cooperativeness of the child during dental visits. A modification to the Frankl scale
was suggested to add a fifth rating in order to make the scale more accurate and further reflective.
Clinical Significance: The need for more accurate scales had led to thinking about adding a new
category to the Frankl scale. Once the child’s behavior is assessed accurately, a clear planning for the
ensuing visits could be achieved and behavioral management techniques are tailored to that specific
child to help reduce the anxiety level.

73. Facial imaging scale

74. Melamed., et al. (1978) developed the Behavior Profile
Rating Scale (BPRS) which consists of 27 behavioral
aspects during dental visits .
This scale was designed to allow an independent observer
to record the frequency of the disruptive behavior during 3-
minute observation periods.
Four of the items apply to behavior of the child upon
separation of the mother, while the other 23 statements
assess office behavior; of which 2 of them concern the
dentist and the remaining 21 concern the behavior of the
child.

75. The Categorical Rating Scale developed by Nazif
(1971) was used to assess four aspects of behavior:
crying, cooperation, apprehension, and sleep

76. conclusion
Child psychology tries to describe and explain all aspects of child
development including cognitive, social and physical development
and support children experiencing delays.
Helping children understand their emotions early can have a
powerful impact on current and future emotional development.

77. REFERENCES:
1) PAEDIATRIC DENTISTRY – SHOBHA TANDON, 3rd EDITION
2) TEXTBOOK OF PEDIATRIC DENTISTRY – NIKIL MARWAH, 3rd EDITION
3) Riba, Hicham. (2017). A Review of Behavior Evaluation Scales in
Pediatric Dentistry and Suggested Modification to the Frankl Scale. EC
Dental Science. 16. 269-275.
4) INTERNET SOURCES