The document provides an overview of various theories related to child psychology and their importance in dentistry. It discusses Sigmund Freud's psychosexual stages of development including the oral, anal, phallic, latency, and genital stages. It also covers Erik Erikson's psychosocial stages of development from birth through adulthood. Additionally, the document summarizes Jean Piaget's theory of cognitive development including the sensorimotor stage from birth to age 2 where infants use senses and motor abilities to understand the world.

1. Presented by-
Shubham Gupta

2. “A dentist who fails to attend the psychological needs of a child will soon deal with an
un cooperative patient”
-David C Johnsen

4. CONTENTS
 Introduction
 Definition
 Approaches
 Importance of studying child psychology
 Theories of child psychology
 References

5. INTRODUCTION
• The term psychology comes from two Greek words, psyche,
meaning the soul, and logos, referring to the study of a
subject.
• Child Psychology is the science that deals with the mental
power or an interaction between the conscious &
subconscious elements in a child. (Kenneth Clark And George
Miller 1970).
Theories of personality, Jess Feist, Gregory J Fiest,sixth edition

6. • Psychological development is a dynamic process, which begins
at birth and proceeds in an ascending order through a series
of sequential stages manifesting into various characteristic
behaviour.

7. IMPORTANCE OF CHILD PSYCHOLOGY IN DENTISTRY ?
Understand the problems psychologically
Gain child’s and parent’s confidence

8. Know the child patient better
Establish effective communication

9. Teach and motivate about importance of oral health
and preventive care
Deliver dental service in meaningful
and effective way

10. APPROACHES IN PSYCHOLOGY
-Biological
-Behavioural
-Cognitive
-Cross Cultural
-Evolutionary
-Humanistic
-Psychodynamic

11. PSYCHODYNAMIC THEORIES
– Psychosexual/ psychoanalytic theory - Sigmund Freud
(1905)
– Psychosocial theory/ model of personality development -
Erik Erikson (1963)
– Cognitive development theory - Jean Piaget (1952)
THEORIES PROPOSED ON CHILD PSYCHOLOGY
Theories of personality, Jess Feist, Gregory J Fiest, sixth edition.

12. BEHAVIORAL LEARNING THEORIES
– Classical conditioning -Ivan Pavlov (1927)
– Operant conditioning - Skinner B.F. (1938)
– Social learning theory - Albert Bandura (1963)
– Theory of hierarchy of needs – Abraham Maslow (1954)

13. PSYCHOANALYTICAL THEORY
SIGMUND FREUD (1905)

14. • Austrian Physician - based on his clinical work with patient
suffering from mental illness (1887-1897).
• He listened to their accounts of dreams and fantasies as well
as their ‘uncensored’ streams of thought, and construct an
elaborate, multifaceted theory.

15. MIND
Conscious
Preconscious
Unconscious
PSYCHOSEXUAL STAGES OF DEVELOPMENT
Oral
Anal
Phallic
Latency
Genital
PARTS OF PERSONALTY
Id
Ego
Super ego
DEFENSE MECHANISMS
Repression
Displacement
Projection
PSYCHODYNAMIC
APPROACH

16. 16
STRUCTURE OF PERSONALITY

17. ID
• Consist of that portion of the mind that contains the
unconscious drives for pleasure and destruction.
• Strives for immediate satisfaction of its drives.

18. • Ways by which id tries to achieve reduction of tension:
• Reflex action
– Simple response.
– Occurs reflexively to stimulus in the environment.

19. • Primary process thinking:
– Creation of fantasy about an object or behavior to reduce
tension and satisfy the id’s drives.

20. EGO
• It is the integrating or mediating part of personality, which
develops out of interaction of id and environment.

21. • The ego is the agent of reason, commonsense, and defense.
• Delayed gratification- will eventually allow the behavior, but
only in the appropriate time and place.

22. SUPEREGO
• The superego incorporates the values and morals of society
which are learned from one's parents and others.
• The superego consists of two systems: The conscience and the
ideal self.

23. • It is the internal part of the individual that makes value
judgments.
• Behavior which falls short of the ideal self may be punished by
the superego through guilt.
• The super-ego can also reward us through the ideal self when
we behave “properly‟ by making us feel proud.

24. • Infants are governed by the id.
• As they grow older, their egos develop.
• Early childhood- superego.
• The emotionally healthy person- develops a strong ego, able
to cope up with urges of ego and superego.

26. Theories of personality, Jess Feist, Gregory J Fiest, sixth edition

27. LEVELS OF MENTAL LIFE

29. UNCONSCIOUS
• The unconscious contains all those drives, urges, or instincts
that are beyond our awareness but that nevertheless
motivate most of our words, feelings, and actions.

30. • Freud believed that a portion of our unconscious originates
from the experiences of our early ancestors that have been
passed on to us through hundreds of generations of
repetition.

31. PRECONSCIOUS
• The preconscious level of the mind contains all those
elements that are not conscious but can become conscious
either quite readily or with some difficulty.

32. • The contents of the preconscious come from two sources, the
first of which is conscious perception.
• The second source of preconscious images is the unconscious.

33. CONSCIOUS
• Consciousness, which plays a relatively minor role in
psychoanalytic theory, can be defined as those mental
elements in awareness at any given point in time.

34. • Ideas can reach consciousness from two different directions
– The first is from the perceptual conscious system.
– The second source of conscious elements is from within
the mental structure.

35. PSYCHOSEXUAL STAGES OF
DEVELOPMENT
• Oral stage (0 – 18 months)
• Anal stage (18 months -3yrs)
• Phallic stage (3-5yrs)
• Latency period (5-puberty)
• Genital stage (puberty onwards)

36. ORAL STAGE: 0 – 18 MONTHS
• The main source of erotic stimulation is the mouth.
• Hunger is satisfied by oral stimulation.
• In Freud’s view, the handling of the child’s feeding experiences
is crucial to subsequent development.

37. 37
• Digit sucking habit in older individuals- shows some form of
dependency .
• According to Freud, symptoms of fixation at the oral stage are
smoking, drinking, chewing habits of gums, pens, pencils, nail
biting, overeating, sarcasm ( the biting personality) and verbal
hostility.

38. CLINICAL APPLICATION
• The baby learns that manipulation of the mouth, and
especially the lips and tongue, whether on the breast or
bottle, brings happiness and satisfaction.
• The dentist may encounter patients because whose thumb
sucking behavior has resulted in the development of dental
problems such as malocclusions.

39. ANAL STAGE: 1.5 - 3 YRS
• Anal zone- primary source of pleasure.
• Children get their erotic pleasure from their bowel
movements, through either the expulsion or retention of
feces.

40. • The crucial event at this time is toilet training.
• Excessive punishment might produce a latent feeling of
hostility toward the “trainer,” usually the mother

41. • Anal expulsive personality – excessive sloppiness,
disorganized, reckless, careless, defiant behavior.
• Anal retentive personality – obsessively clean, orderliness,
meticulous, withholding, passively aggressive.

42. PHALLIC STAGE: 3-5 YRS
• The genitals become the focus for the child’s erotic energy.
• Probably the most challenging stage in a person’s
psychosexual development.
• During this stage, the Oedipus and Electra complex emerges.

43. • Oedipus complex:
– Named after young king in Greek myth who killed his father and
married his mother unaware of their true identities.
– A boy’s feelings for his mother and rivalries with his father and
tries to imitate the father to impress his mother.

44. • Boys in the midst of their Oedipus complex, often experience
intense castration anxiety that comes from fear of
punishment from father for their desire for the mother.

45. • Electra complex:
– A girl’s feelings of inferiority and jealousy turns affections
from mother to father.
– Also involves penis envy.

46. – According to Freud, the girl believes that she once had a
male genital but that it was removed.
– In order to compensate for its loss, the girl wants to have a
child by her father.

47. • The child who successfully resolves this convict learns to
control envy and hostility and begins to identify with model
after the parent of the same sex, through which the ego
obtain partial satisfaction – identification.

48. • Weak or confused sexual identity (may be considered the root
cause of homosexuality) may also be afraid of incapable of
love or intimacy.

49. LATENCY STAGE: 5-13YRS
• Freud believed that, from the 4th or 5th year until puberty,
both boys and girls usually, but not always, go through a
period of dormant psychosexual development.
• This latency stage is brought about partly by parents' attempts
to punish or discourage sexual activity in their young children.

50. • If parental suppression is successful, children will repress their
sexual drive and direct psychic energy toward school,
friendships, hobbies, and other nonsexual activities

51. • When the young person reaches puberty or sexual
maturation, he or she enters the genital stage during which
the person feels strong and adult sexual interests and desire
for the first time.
GENITAL STAGE: 13YRS ONWARDS-ADULTHOOD

52. • According to Freud, if people experience difficulties at this
stage, it will be due to the damage from the earlier oral, anal
and phallic stages.

54. • Pessimistic approach to personality.
• Pathology based theory.
• Over emphasis to infantile sexuality.
• No controlled studies-poor research.
• Overemphasis on differences between men and women.
• Unconcerned with interpersonal relations, individual identity
and adaptation over one’s lifetime.
LIMITATIONS OF FREUD’S WORK

55. PSYCHOSOCIAL THEORY
ERIC H. ERIKSON (1963)

56. • According to him there are eight stages in the human life
cycle, sequence of which is set by nature.
• Each stage is associated with an inherent conflict or crisis
that the individual must encounter and successfully
resolve to proceed with development.

58. Birth to
18
months

59. 59
• Infants’ most significant interpersonal relations are with
their primary caregiver, ordinarily their mother.
• If they realize that their mother will provide food regularly,
then they begin to learn basic trust.
STAGE 1
BASIC TRUST VS. MISTRUST

60. • However, if the care is inconsistent, inadequate and rejected a
basic mistrust is fostered.
• Fear and suspicion develops towards the world in general and
people in particular which continues through later stage of
development.

61. • Dental treatment at an early age is preferably done in the
parent’s presence and if possible while the child is being held
by one of the parents.
• At later stage a child who never developed a sense of basic
trust is likely to be an extremely frightened and uncooperative
patient who needs special effort to establish trust and support
with the dentist and staff.

62. 18 months
to 3 years
I am,
look at
me

63. • If early childhood is a time for self-expression and autonomy,
then it is also a time for shame and doubt.
• The emerging autonomy (independence) builds on the child’s
motor and mental abilities.
STAGE 2
AUTONOMY VS. SHAME AND DOUBT

64. • If the parents recognize the young child’s capabilities, allow
him to develop at his own pace and reassure when he makes
mistakes, then a sense of self-control of muscles, impulse and
the environment is developed, which will contribute to the
confidence needed to cope with future situations that require
choice, control and independence.

65. • However, when the caretakers are overprotective or impatient
and do everything for the child, they reinforce a sense of
shame and doubt.

66. • Dental visit
– Make him/her feel more important.
– Let child think whatever dentist wants is his/her own
choice.
– Let parent be with.
– Sedation/GA – complex procedures.

67. 3 to 6
years
I will try

68. STAGE 3
INITIATIVE VS. GUILT
• Continues to develop greater autonomy.
• Whether the child leaves this stage with a sense of initiative or
guilt depends on how the parents respond to self-initiated
activities.

69. • Initiative is also reinforced when parents answer their
questions.
• On the other hand if the child is made to feel that certain
activity is bad, that the question are nuisance then the child
may develop a sense of guilt over self-initiated activities in
general.

70. • Dental visit
– First dental visit – new & challenging.
– Exploratory visit of the dental office.
– On the other hand if the child is poorly managed, the
dentist visit can result in sense of guilt that accompanies
failure.

71. 6 to 11
years
I’m capable

72. STAGE 4
INDUSTRY VS. INFERIORITY
• Acquiring academic & social skills.
• Period of shift from home to peer group.
• Competition with others becomes reality.

73. • Dental visit
– Behavioral guidance is done at this stage.
– Because the child’s drive for a sense of industry and
accomplishment, cooperation with treatment can be
obtained.
– Motivated by peer group acceptance & improvement in
status.

74. 12 to 17
years

75. STAGE 5
IDENTITY VS. ROLE CONFUSION
• Extremely complex stage.
• According to Erikson, adolescence integrates the healthy
resolutions of all the previous conflicts.
• Maturation is seen mentally and physiologically.

76. • Become capable of constructing theories and philosophies
designed to bring all the varied and conflicting aspects of
society into a working, harmonious and peaceful whole.

77. • Erikson believes that the new interpersonal dimension that
emerges during this period has to do with a sense of ego
identity at the positive end and a sense of role confusion at
the negative end in which the adolescence is unable to make
decisions and choices, especially about vocation, sexual
orientation and his role in life and society in general.

78. • Dental visit
– Behavior management - extremely challenging.
– Approval of peer group is extremely important.
– Abstract concepts are grasped readily.

79. STAGE 6
INTIMACY VS. ISOLATION
• Attainment of intimate relationship – willingness to share
mutual trust.
• Successful if both have stable egos.
• Working towards career goals.

80. STAGE 7
GENERATIVITY VS. STAGNATION
• Generativity is the concern in establishing and guiding the
next generation.
• Look outside oneself & care for others

81. STAGE 8
EGO INTEGRITY VS. DESPAIR
• Integrity – sense of satisfaction of lived productive life.
• Despair – sense that life has had little purpose/meaning.

82. Stage Psychosocial
crisis
Significant
social
relationships
Favourable
outcome
First year Basic trust vs
mistrust
Mother Trust and
optimism
2 to 3yrs Autonomy vs
shame
Parents A sense of self
control and
adequacy
4 to 6yrs Initiative vs
guilt
Basic family Ability to take
initiatives
6 to 11yrs Industry vs
inferiority
Neighborhood,
school
Competition in
intellectual,
social skills
Adolescence Identity vs role
confusion
Peer groups,
models of
leadership
Unique image
of self

83. Demerits Merits

84. REFERENCES
1. Pediatric dentistry - Infancy through adolescence 3rd edition by JR
Pinkham.
2. Paediatric dentistry principles and practice- 2nd edition by MS
Muthu.
3. Theories of personality, Jess Feist, Gregory J Fiest, sixth edition.
4. The developing person through childhood and adolescence,
Kathleen Stassen Berger, sixth edition.
5. Ralph E. McDonald ,David R. Avery Dentistry for the Child and
Adolescent (8th Edition).Elsevier Science.
6. Behaviour Management in Dentistry for Children 2nd edition by
Gerald Z. Wright Ari Kupietzky .

86. Presented by-
Shubham Gupta
Pediatric and
Preventive Dentistry

87. Contents-
-Cognitive Development
-Classical Conditioning
-Operant Conditioning
-Observational theory
-Hierarchy of Needs
-Separation and individualization theory

88. COGNITIVE DEVELOPMENT
JEAN PIAGET (1952)

89. • A cognitive structure is described as an organized pattern of
thought that an individual develops to make sense of some
aspect of self - experience.
• They are active and curious explorers who construct a newer
understanding of the world around them based on their
experiences.

91. In this process, their cognitive structures takes place in four steps:
– Assimilation
– Disequilibrium
– Accommodation
– Organization

93. It is an approach to psychology that attempts to explain
human behaviour by understanding your thought
processes.

94. SENSORIMOTOR STAGE – 0-2YRS
• The first stage in the growth and development
of a child.
• Infant use sense of motor abilities to
understand the world.
• There is no conceptual or reflective thought

95. • Knowledge of the world is limited to sensory
perception and motor activities.
• Behavior is limited to simple motor responses
to sensory stimuli.

96. • During second year children are capable of
discovering a hidden object even after it has been
removed from one hiding place to another.
• Symbolic thought is developed towards the end of
this stage, which is the capacity to construct a
mental representation of an object – a symbol.

97. • Animism is imparting life to inanimate
objects, like furniture, wall, floor or doors and
if the child gets hurt by those objects the child
will feel happy by hitting them or if the
caretaker or parents hit them.

98. CLINICAL APPLICABILITY
– Non- co-operation may be disregarded in such a young
child as he is not able to reason.
– Patient may be instituted forcibly of need be, as it will not
have permanent effect on the child because concept of
object permanence has not developed.

99. PREOPERATIONAL STAGE
• The child on this stage is able to reason and give logical train
of thoughts.
• Animism and symbolic thoughts are seen.
• Do not understand concrete logic and cannot mentally
manipulate information.

100. • Egocentrism, centration, irreversibility and lack of
conservation are hallmark of this stage.
• Description of pain presented by the child during
this stage reflects the developmental level.
• At this stage they are influenced by what they see.

101. DENTAL VISIT-
• Egocentrism -- Make them feel more
important.
• Animism -- investing inanimate objects
with life. symbolic fantasy, play and
language. Giving dental instruments and
equipment life
• Constructivism – child acquires reality by
touching, exploring, observing

102. STAGE OF CONCRETE OPERATIONS
• Became capable of logical reasoning, period during which the
child begins to understand logical concepts.
• The child no longer makes judgment solely on the basis of
how things appear.
• They develop the qualities of reversibility and decentration.
- The developing person through childhood and
adolescence, Kathleen Stassen Berger, sixth edition.

103. • Child thinking is more reasonable and stable
and can understand many relationships with
cause and effect.
• With his knowledge he can understand that
specific procedures caused pain.

104. PERIOD OF FORMAL OPERATIONS
• Characterized by remarkable cognitive growth, when
children‘s development of language and acquisition of basic
skills accelerate dramatically.
• Children at this stage utilize their senses in order to know; they
can now consider two or three dimensions simultaneously
instead of successively.

105. • The importance of hands-on activities cannot be
overemphasized at this stage.
• These activities provide students an avenue to make abstract
ideas concrete, allowing them to get their hands on
mathematical ideas and concepts as useful tools for solving
problems.

106. CLINICAL APPLICATION
– The child tries to apply logic for
everything hence one must explain
everything. E.g. why extraction not filling.

107. • Most comprehensive theory of
cognitive development
• Highlights children’s intellectual
development from examining their
incorrect and correct
Merits
• Underestimates children’s
abilities.
• Overestimates age
difference in thinking.
• Vagueness about process
of change.
Demerits
Vygotsky and Bruner
said that development
is a continuous
process rather than
stages

108. LEARNING THEORIES
Learning:
Relatively permanent changes in the
behavior that occurs as a
result of experience.
Behavior:
Result of an interaction between innate or
instincts and
learning after birth.

109. Three distinct mechanism
1. Direct exposure to the events by experiencing them
(classical conditioning) or by acting & seeing the
consequences of our actions (operant conditioning).
2. Watching others experience the events (observational
learning).
3. Through language.

110. BEHAVIOURAL
LEARNING

111. CLASSICAL
CONDITIONING
Theory by Ivan Pavlov (1903)

112. • Pavlov was studying the role of saliva in the
digestive processes of dogs when he stumbled
onto what he called ―psychic reflexes.
• Like many great discoveries, Pavlov’s
discovery was partly accidental, although he
had the insight to recognize its significance.

114. Process of classical conditioning
1. Acquisition
2. Generalization
3. Discrimination
4. Extinction
5. Spontaneous recovery

116. • The typical paradigm involves repeatedly
pairing an unconditioned stimulus that
naturally evokes a certain response called the
unconditioned response with a neutral
stimulus, in fact described as stimulus
substitution.

117. • After repetitive pairings of the neutral
stimulus with the unconditioned stimulus, the
neutral stimulus comes to elicit the same
response as the unconditioned stimulus.

118. • The neutral stimulus has become a conditioned stimulus the
response to the conditioned stimulus is called a conditioned
response.
• This mode of learning is also called as “learning by
association”/ “Classical conditioning” operates by simple
process of association of one stimulus with another.

119. OPERANT
CONDITIONING
B.F. Skinner (1938)

120. • Term “operant” refers to the notion that humans learn from
operating on their environment.
• We behave, then note the consequences and use them to
modulate future behavior.
• Operant conditioning involves exploratory or goal – seeking
actions and their consequences.

121. PROCESS OF
OPERANT
CONDITIONING
Acquisition and
Shaping

122. • Skinner believed that an organism ‘operates’ on the
environment instead of simply reacting to stimuli and
encounters a special kind of stimulus called ‘reinforcing
stimulus’ or a reinforcer.
• This special stimulus has the effect of increasing the operant,
the behavior occurring just before the reinforcer.

123. • The consequences can be one of the three:
– Reinforcement
– Omission
– Punishment

125. Four basic principles:
1. Positive reinforcement--- pleasant
consequence follows a response.
e.g. Reward for co-operation.
2. Negative reinforcement --- withdrawal
of an unpleasant stimulus after a
response.
e.g. Stopping treatment if crying.

126. 3. Omission (time out)---removal of a
pleasant stimulus after a particular
response.
e.g. Taking out of favorite toy.
4. Punishment ---when an unpleasant
stimulus is presented after a response.
e.g. Sending mother out.

127. Positive reinforcement Negative reinforcement
Positive punishment Negative punishment
Stimulus
added to the
environment
Future
possibility of
behavior
increases
Stimulus
removed
from the
environment
Future
possibility of
behavior
decreases
Future
possibility of
behavior
increases
Future
possibility of
behavior
decreases
Stimulus
removed
from the
environment
Stimulus
added to the
environment

128. SOCIAL LEARNING
THEORY (1963)
ALBERT BANDURA

129. OBSERVATIONAL
LEARNING • Observational learning process
1. Attention process
2. Retention process
3. Reproduction process
4. Motivational process
• Factors affecting observational
learning
1. Expected consequences of the
behaviour
2. Characteristics of role model

131. Role of modelling in
dentistry

132. • Acquired through
observation and
imitation.
• Bobo doll.
• Eg. Television
commercials.
• “Learning would be
laborious, not to
mention hazardous,
if people had to rely

133. SOCIAL LEARNING
THEORY
• General principle
– Observing others behavior & its outcome
– May/may not change behavior
– Cognition play a role

134. Social learning theory
-Types of reinforcers
The model
Third person
Imitated behavior itself
Consequences of model’s behavior

135. • Components
– Attention –ability to perceive & attend to
significant features of the modeled
behavior
– Retention – coding the information into
long-term memory
– Motor reproduction - learn and posses the
physical capabilities of the modeled
behavior

136. APPLICATIONS IN DENTISTRY
• One should explain the procedure to the child
• Make him/her observe other person showing
desired behavior (live or audiovisual)
• Ask him to imitate the desired behavior
• Reinforce the same
Children have never been good listeners to
elders, but they never
fail to imitate them.

137. THEORY OF HIEARCHY OF NEED
Abraham Maslow (1943)
What a
man can
be, he
must be

138. 138
• Developed by observing basic needs of
individuals.
• Lower level needs must be satisfied before
higher level needs become motivators.

139. Theories of personality, Jess
Feist, Gregory J Fiest, sixth
edition.

140. HIERARCHY OF NEEDS
• Physiological Needs
• Basic needs - air, water, food, sleep, etc.
• Not satisfied - feel sickness, irritation, pain,
discomfort
• Motivate to alleviate them as soon as possible to
establish homeostasis.
• Safety needs
• Stability & constancy in a chaotic world.. e.g security
of home & family

141. • Love & belonging needs
We need to be needed. Loving and caring
partners, children, friends, society
• Esteem needs
• Self esteem– by mastery of task, respect from
others

142. Self actualization
“The desire to become more and more what
one is, to become everything that one is capable
of becoming."
They can easily tolerate the absence of basic
need.
Reality centered, problem centered, respect
self and others accompanied with strong ethics.

143. • Unable to differentiate between himself and the
outside world.
• Emotional needs are largely physical in nature -
gratification of those needs by the mother as
occurring as if by magic.
SEPARATION AND
INDIVIDUALIZATION(1933)
MARGARET MAHLER
Normal Autistic Phase - Birth to 1 month.

144. Normal Symbiotic Phase -1-5
months
• Begins with an increased sensitivity and
awareness to external stimuli .
• Task of this phase is the formation of the
mother-infant bond and outside world .

145. Sub phase I: Differentiation – 5-10 months
• Begins with increasing exploration of mother,
her face in particular, skin.
• Curious of external world.

146. Sub phase II: Practicing – 10-16
months
• The baby can physically leave the mother -
crawling or climbing & upright locomotion

147. Sub phase II: Practicing – 10-16
mnths
• Separation anxiety .
• Self esteem.

148. Sub phase III: Rapprochement - 16 to 24
mnths
• Begins to appreciate himself as a separate being.
• Exploration of the environment continues.

149. Sub phase IV:
Consolidation and Object Constancy - 24-36
months
• Development of object constancy.
• Comfortable in mothers absence.

150. REFERENCES
1. F.T. McIver and W Proffit Contemporary
Orthodontics 6th Edition by William
Proffit Henry Fields Brent Larson David Sarve.
Chapter 2 Section II Page 58-70.
2. N Sivakumar ,MS Muthu Paediatric dentistry
principles and practice- 2nd edition. Chapter 7
,pg 71-89.
3. Theories of personality, Jess Feist, Gregory J
Fiest, sixth edition.
4. Image source – Google.