Stages of child development and theories of psychological development

Dr. KUNAAL AGRAWAL
PG STUDENT
DEPT. OF ORTHODONTICS
GDCRI, BANGALORE

STAGES OF CHILD DEVELOPMENT
AND
THEORIES OF PSYCHOLOGICAL
DEVELOPMENT
2

CONTENTS
• Introduction
• Definitions
• Importance of Child Psychology
• PSYCHODYNAMIC THEORIES
– Psychosexual theory – Sigmund Freud – 1905
– Psychosocial Theory – Eric Erickson – 1963
– Cognitive Theory – Jean Piaget – 1952
• BEHAVIORAL LEARNING THEORIES
– Classical conditioning – Ivan Pavlov – 1927
– Operant conditioning – Skinner B.F. – 1938
– Social Learning Theory – Albert Bandura – 1963
– Hierarchy of Needs – Abraham Maslow – 1954
3

• Margaret Mahler Theory of Development (1933)
• Observational Learning / Modeling
• Conclusion
• References / Bibliography
4

DEFINITIONS
• PSYCHOLOGY : Science dealing with human nature,
function and phenomenon of his soul in the main.
• PSYCHOLOGY : Psychology is the science of mental life,
born of its phenomena and of their conditions. The
phenomena are such things as we call feelings, desire,
cognitions, reasoning, decisions and the like (William
James, 1890).
• BEHAVIOR : Any change observed in functioning of an
organism.
8

• CHILD PSYCHOLOGY : It 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).
• EMOTION : A feeling or mood manifesting into motor or
glandular activity. Also, an effective state of
consciousness in which joy, sorrow, fear, hate or the
likes are expressed.
9

IMPORTANCE OF CHILD PSYCHOLOGY
IN DENTISTRY
• To understand the child better
• To provide immediate dental needs
• To know the problem of psychological origin
• To deliver dental services in a meaningful and effective
manner
• To establish effective communication with a child and
parent
10

• To teach the child and the parents,
the importance of primary and
preventive care.
• To gain confidence of the child and
the parent.
• To have a better treatment planning
and interaction with the other
discipline.
• To produce a comfortable
environment for the dental team to
work on the patient.
• To understand child as he comes to
dental office and know his problems
in the way he explains.
11

HISTORY OF CHILD PSYCHOLOGY
• The earliest civilizations attributed madness
to magical/divine forces.
• The treatments were administered mostly by
priests and were grounded in religious
beliefs and rituals.
• The origin of psychology was traced by
Greek philosopher, Aristotle, who was
chiefly interested in what the human mind
could accompany.
• In 1700’s, Rene Descartes, a French
philosopher, described body and mind as
separate structures that strongly influenced
one another.
• In the mid 1800’s, Johannes Miller and
Hermann Von Helmholthy began the 1st
systematic studies of sensation and
perception.
12

• In 1875, William James founded the 1st lab.
• In 1879, Wilhelm Wundt, founded a similar lab in
Germany.
» Many disagree to Freud's ideas but most accept his
concept that unconscious mind plays a major role
in shaping behavior. Similarly most psychologists
agree with the behaviorists that environment
influences behavior.
• Another group called Cognitive School believes that there is more
to human nature than a series of stimulus - response connections.
• Humanistic Psychology developed as an alternative to behaviorism
& psychoanalysis. This was supported by Abraham Maslov and
Carl Roger.
13

IMPORTANT THEORIES OF CHILD
PSYCHOLOGY
ACCORDING TO KENDELL AND ZEALEY :
I] PSYCHODYNAMIC THEORIES –
– Psychosexual theory/Psychoanalytic Theory – Sigmund Freud – 1905
– Psychosocial theory/Model of Personality Development – Erik Erikson –
1963
II] BEHAVIORAL LEARNING THEORIES –
– Classical Conditioning – Ivan Pavlov – 1927
– Operant Conditioning – Skinner B.F. – 1938
III] MARGRET MAHLER THEORY OF DEVELOPMENT 14

15
WHY ARE THEORIES IMPORTANT ?

• Useful in integrating and abstracting interrelatedness of
natural phenomenon.
• They are like a quest for unknown and uncertain.
• Predict future events and in some instances control
forces of nature.
• Provide pleasure to the scientist of his own creation.
16

PSYCHODYNAMIC THEORIES
ARCHAIC DISCHARGE SYNDROME
• This theory was put forward by
“SIGMUND FREUD” (1856-1939);
who was an Viennese Neurologist
has been called as “Father of
Modern Psychiatry”.
17

• According to him human body contains 2 types of
neurons which are :
– Psi neurons – for storage of emotions, and
– Phi neurons – for conduction of emotions.
• When the stored emotion reaches a certain level, a
discharge is sparked off leading to overt displays of
emotions and it is called as archaic discharge.
18

• Freud attempted to explain the personality and
psychological disorders in an individual by
understanding the mind at different levels, its
motivation and conflicts. He described human mind
with the help of 2 models –
1. Topographic model
2. Psychic triad
TOPOGRAPHIC MODEL
• According to him, human mind consists of
– Conscious mind
– Preconscious mind
– Unconscious/Subconscious mind
19

1. 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.
21

2. 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.
22

3. 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.
23

Freud described human mind like an iceberg. Only 10% of the
iceberg is visible (conscious) whereas 90% of iceberg is beneath
(unconscious)
24

PSYCHIC TRIAD
SUPER
EGO
EGO
ID
25

1. Id
• Born with it.
• Important part of our
personality, which serves
as a reservoir of instincts
of their mental
representative.
• 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.
• Pleasure Principle.
26

2. Ego
• The rational part of the mind.
• Develops around 2-6 months of age, when infant begins to
distinguish between itself and the outside world.
• To be reasonable and bear the long-term consequences in
mind.
• Uses secondary processes (perception, recognition,
judgment and memory). Concerned with memory and
judgement.
• Reality Principle.
27

3. Superego
• Prohibition learned from
environment (more from parents
and authorities).
• Emerge at around age five.
• It holds all of our internalized
moral standards and ideals.
• Superego provides guidelines for
making judgments, i.e. our sense
of right and wrong.
• There are two parts of the
superego:
 Ego Ideal
 Conscience
28

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
29

Ego Defenses
• Rationalization: Giving excuses for
shortcomings and thereby avoiding self-
condemnation, disappointments, or
criticism by others.
30

• Projection: Attributing one's own
unacceptable thoughts, feelings, impulses
to others.
31

• Displacement: Redirecting our impulses
(often anger) from the real target (because
that is too dangerous) to a safer but
innocent person.
32

• Reaction Formation: Reversal of our
feelings, overacting in the opposite way to
the fear.
33

• Denial: Claiming/believing that what is
true to be actually false.
34

• Regression: Giving up of mature problem
solving methods in favor of child-like
approaches to fixing problems.
35

• Sublimation: Transforming unacceptable
needs into acceptable ambitions and
actions.
36

• Identification: This is incorporating an
external object (usually another person) into
one’s own personality, making them part of
one’s self. Eg, one may come to think, act
and feel like someone else.
37

PSYCHOSEXUAL STAGES
OF DEVELOPMENT
 ORAL STAGE (0-1.5 years)
 ANAL STAGE (1.5-3 years)
 PHALLIC STAGE (3-6 years)
 LATENCY PERIOD (6 years-
puberty)
 GENITAL STAGE [puberty-
(11-13) onwards]
39

1. ORAL STAGE
(Birth to 1st year)
 Psychoanalysts refer to this first year of life as the oral
period, a time when the child experiences pleasure from
oral gratification of seeking and eating.
 In infants, the oral cavity is the site for identifying needs;
therefore serving as an erogenous zone.
 Towards the middle of 1st year of life, the infant acquires
teeth and is provided with another pleasurable outlet
that of biting and chewing.
40

• Satisfaction of oral desires, eg. suckling
of milk, help in development of trust.
• If the stages are completed successfully,
the result is a healthy personality. If
certain issues are not resolved at the
appropriate stage, fixation can occur.
• For example, a person who is fixated at
the oral stage may be over-dependent on
others and may seek oral stimulation
through smoking, drinking, or eating.
41

2. ANAL STAGE
(1.5 – 3 years)
• Erogenous Zone in Focus: Anus
• Maturation of neuromuscular control
• Development of personal autonomy and independence
• Gratifying Activities: Bowel movement and the
withholding of such movement
• Toilet training
• Discover their own ability to control
• Autonomy, sense of shame
• Period of striving of independence
42

2.1 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.
 Anal-Retentive Personality: If a child receives
excessive pressure and punishment, he/she will
experience anxiety over bowel movements.
 Very careful, stingy, withholding, obstinate, meticulous.
43

3. PHALLIC STAGE
(4-5 years)
• Probably the most challenging
stage in a person's psychosexual
development
• "Oedipus Complex"
• "Electra Complex”
• Castration Anxiety
• Penis envy
• Differentiating between sexes
• Child realizes sexual qualities without embarrassment
44

• Success or failure to resolve the conflict, he or she will
have learnt to control their envy and hostility and begin
to identify with and model the parent of their own sex.
• If those characteristics are not resolved, the balance
between male and female roles doesn’t develop.
45

4. LATENCY STAGE
(6-12 years)
• 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.
• Maturation of ego takes place.
• Greater degree of control over instinctual impulses.
• Lack of inner control results in an immature behavior
and decreased development of skills.
46

LATENCY PHASE….
• Resolution of any defects
• Maturation of ego
• Greater control over instincts
• Consolidation of sex roles
• Mastery over skills
• Phase ends in puberty
47

5. 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.
48

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.
49

Limitations of Freud’s Theory –
 Based only on the sexual drive
 Based on studies conducted on few patients, that too, adults,
and its extrapolation to children is not very well justified
 Complicated and not very practically applicable
 Has been a source of constant criticism and debate
(sexuality, Oedipus complex)
 The importance of people besides parents to influence the
behavior of children is neglected
 Concentrates more on biologic drives. Freud himself admitted
this lack of balance in his theory
50

COGNITIVE-DEVELOPMENTAL THEORY
Jean Piaget, 1963
• The most famous cognitive-developmental theorist was
Jean Piaget.
• He considered cognition to be a biological process and
was interested in how the thinking brain functions to
process incoming information.
• Piaget’s is an age-stage theory of development that
stresses the action of the mind on the environment.
• Piaget believed that intellectual development proceeds
in an orderly sequence that is characterised by specific
growth stages.
51

• Made up of three functional variants –
 Assimilation – people take in new experiences
through their own system of knowledge
 Accommodation – for intelligence to develop, child
should also have complementary process, i.e.,
accommodation : child adjusts to reality demands
 Equilibration – changing basic assumption following
adjustments in assimilated knowledge so that facts
fit better
52

Sensorimotor Stage (0-2 years)
Pre-Operational Stage (2-6
years)
Concrete Operations
Stage (6-12 years)
Formal
Operation Stage
(11-15 years)
54

Piaget’s Cognitive-Developmental
Stages
1. Sensorimotor Stage (0 - 2 years)
• This stage occurs between the ages of birth and two years
of age, as infants begin to understand the information
entering their sense and their ability to interact with the
world.
• Object Permanency or the ability to understand that these
objects do in fact continue to exist.
• Ability to understand that when mom leaves the room, she
will eventually return, resulting in an increased sense of
safety and security.
Dental Application –
• Child begins to interact with the environment and can be
given toys while sitting on the dental chair in his/her
hands.
55

2. Preoperational Stage (2-7 years)
• Children learn how to interact with their environment in a
more complex manner through the use of words and
images and symbols.
• This stage is marked by Egocentrism, or the child’s belief
that everyone sees the world the same way that he/she
does. Concept of centration.
• Conservation, which is the ability to understand that
quantity does not change if the shape changes.
56

Dental Applications –
• Constructivism – the child likes to explore things and
make his own observations. Eg, child surveys the dental
chair, airway syringe.
• Cognitive equilibrium – child is explained about the
equipment or instrument and allowed to deal with it.
Eg, airway syringe.
• Animism – child correlates things with other objects to
which they are more used to or accustomed. Eg.
Explaining about radiograph as tooth picture.
58

3. Concrete Operations Stage (7-12 years)
• Marked by a gradual decrease in centristic thought and
the increased ability to focus on more than one aspect
of a stimulus.
• Imagine objects or those they have not seen, heard, or
touched, continue to remain somewhat mystical to
these children.
• Abstract thinking is not yet developed.
• Centering – Allowing to hold the mirror to see what is
being done on his teeth.
• Ego centrism – Child has achieved the level of
understanding and gets involved in the treatment. Eg,
he/she holds the suction tip by himself/herself.
59

4. Formal Operations Stage (11-15 years)
• Children begin to develop a more abstract view of the
world.
• They are able to apply reversibility and conservation to
both real and imagined situations.
• Use inductive or deductive logic to make decisions and
solve problems.
• Think of ideas and have developed a vast imagination.
• Failure to achieve this stage has been associated with
lower intelligence.
• Acceptance of treatment from peers can be used as a
motivation for dental treatments.
60

Merits of Cognitive Theory
 His theory was one of the first to explain, and not
just describe, the process of development.
 His description of broad sequences of intellectual
development provides a reasonably accurate
overview of how children of different ages think.
 Piaget’s ideas have had a major influence on
thinking about social and emotional development as
well as many practical implications for educators.
 Piaget asked important questions and drew literally
thousands of researchers to the study of cognitive
development.
64

• Underestimates children’s abilities.
• Overestimates age differences in thinking.
• Vagueness about the process of change.
• Underestimates the role of social environment.
65
Demerits of Cognitive Theory

PSYCHOSOCIAL THEORY
Erik Erikson (1963)
• Psychosocial Theory is the modified version of Freud’s
theory. There’s superimposition of psychosocial &
psychosexual factors simultaneously contributing to
personality development of the child.
 So in essence, this theory postulates, “society responds
to child’s basic needs or developmental tasks in each
specific period of life & states that in doing so the
society assures not only the child’s healthy growth but
also the passage & survival of the society’s own culture
& traditions.”
66

• Erikson concentrated on child’s development covering
the entire span of life cycle from infancy to childhood
through old age.
• Erikson described 8 stages of life cycle which are
marked by internal crises defined as turning
points/periods. Each stage demands resolution before
the next stage can be satisfactorily negotiated.
67

• Infant depends on mother for his/her basic needs
• Proper mothering allows child to develop basic
trust in world.
• Unstable mothering lack of sense of trust.
Clinical importance –
 “SEPARATION ANXIETY”
A child who never developed a sense of basic
trust, at later stages, will have difficulty in
entering into situations that require trust &
confidence in another person. Such an
individual is likely to be an extremely
frightened & uncooperative patient, who
needs special effort to establish rapport &
trust with the dentist & staff.
1. Basic Trust v/s Mistrust - Birth To 18 Months
69

2. Autonomy v/s Shame – 18 months to 3 years
• Child moves away from mother to develop sense of individual
identity or autonomy.
• Toddlers learn to explore and do things themselves. Their self-
control and self-confidence begins to develop at this stage.
• Wants to have his own way.
• Failure to develop autonomy: doubt in child’s mind about his
ability to stand alone.
Clinical importance –
• At this stage to obtain cooperation for t/t make
child thinks whatever dentist wants was his own wish
• Allow parent to be present during t/t
71

72
During the period in which children are developing autonomy, conflicts with siblings, peers, and
parents can seem never-ending. Consistently enforced limits on behavior during this stage, often
called the “terrible twos,” are needed to allow the child to develop trust in a predictable
environment

3. Initiative v/s Guilt - 3 to 6 Years
 Initiative shown by physical activity, extreme
curiosity, questioning and aggressive talking.
 He should be channelized into manageable tasks
and preventing him from undertaking tasks where
success is not possible.
 Guilt results: goals contemplated but not attained.
73

Clinical Significance –
• First visit to dentist comes during this stage. Going to
the dentist can be constructed as a new and
challenging adventure; success in coping with the
anxiety of visiting the dentist can help to develop
greater independence and produce a sense of
accomplishment.
• Child will be extremely curious about the dental office,
so explanatory visit with the mother is helpful.
• Independence rather than dependence is reinforced.
74

4. Industry v/s Inferiority - 7 To 11 Years
• Child acquires academic and social skills preparation
to enter competitive world.
• Sense of inferiority crops when child compares
academically, socially and physically and finds that
someone else can do things better.
• Orthodontic treatment begins at this stage.
75

• Children at this age are trying to learn the skills and
rules that define success in any situation, and that
includes the dental office.
• Interceptive orthodontic treatment often begins during
this stage of development.
• Because of the child’s drive for a sense of industry and
accomplishment, co-operation with treatment can be
obtained. And we should motivate them for the faithful
wearing of the appliance.
76

5. Identity v/s Role Confusion - 12 -17 Years
• Adolescents are concerned how they look
• Withdrawal from family and importance of peer group
increases
• Separation from group
• Uniqueness and value
• Failure to separate from group
• Confusion regarding place in society and low self-esteem
Orthodontic T/T in this phase is instituted only
if patient wants
77

78
Adolescence is an extremely complex stage because of the many new opportunities and challenges
thrust on the teenager. Emerging sexuality, academic pressures, earning money, increased mobility,
career aspirations, and recreational interests combine to produce stress and rewards

• Most of the interceptive orthodontic treatment requires
assistance of behavioral management.
• Poor psychological situation may be created if treatment is
carried out on parent’s insistence and not the child.
• Motivation for seeking treatment may be internal (by
oneself) or external (by others).
• Important to have internal motivation as adolescent actively
desires treatment as something being done for, not to, him/
her.
79

6. Intimacy v/s Isolation - 21 To 40 Years
 Adult stages of development begin with attainment of
intimate relationship.
 Successful development of intimacy depends on
willingness to compromise and even sacrifice to
maintain relationship.
 Success leads to partnerships with mate and with
others of same sex in work to attain career goals.
 Failure leads to isolation.
 Ortho t/t at this age to change appearance which
will facilitate intimate relationships.
80

7. Generativity v/s Stagnation - 45 To 60 Years
Major responsibility of an adult is to guide the next
generation.
Guidance should not be only to one’s own children
but also by supporting network of social services needed
to ensure next generation’s success.
Opposite of stagnation: characterized by self-
indulgence and self-centered behavior.
81

8. Integrity v/s Despair – Over 65 years
• Final stage in psychosocial development.
• Attainment of integrity – sense of satisfaction that a
person feels, in a productive life lived.
82

SIGNIFICANCE OF ERIKSON’S WORK
• Erikson has given a new direction to the treatment of
psychological maladies.
 Erikson’s psychosocial model of the human life cycle has
given the psychologists and the social scientists a powerful
tool to study man and society without compartmentalizing
the two.
85

CRITIQUES AND CONTROVERSIES OF ERIKSON
• Much research has been done on Erikson’s ideas and
theories.
• “It has been proven difficult to create objectives to evaluate
Erikson’s identity theory.” (Marcia, 1980; Waterman, 1985).
• Critics of Erikson’s theory say that his theory is more
applicable to boys than to girls, and that more attention is
paid to infancy and childhood than to adult life, despite the
claim to be a life-span theory.
86

CONTENTS
• Introduction
• Definitions
• Importance of Child Psychology
• PSYCHODYNAMIC THEORIES
– Psychosexual theory – Sigmund Freud – 1905
– Psychosocial Theory – Eric Erickson – 1963
• BEHAVIORAL LEARNING THEORIES
– Classical conditioning – Ivan Pavlov – 1927
– Operant conditioning – Skinner B.F. – 1938
88

• Margaret Mahler Theory of Development (1933)
• Observational Learning / Modeling
• Conclusion
• References / Bibliography
89

THEORIES OF LEARNING AND
DEVELOPMENT OF BEHAVIOR
90

CLASSICAL CONDITIONING
Ivan Pavlov (1927)
• Russian psychologist, Ivan Petrovich Pavlov was one of the
first to study conditioned reflexes experimentally on dogs. The
crucial element of the conditioning is the relation between
the conditioned stimulus and the unconditioned stimulus.
• Classical conditioning was first described by the Russian
physiologist Ivan Pavlov, who discovered in the nineteenth
century during his studies of reflexes that apparently
unassociated stimuli could produce reflexive behavior.
• Principles involved in the process –
91

92
EXTINCTION : extinction of conditioned behavior happens if the association between
the conditioned and unconditioned response is not reinforced. Eg, in above
mentioned example, subsequent visit to the doctor without any unpleasant
experiences results in extinction of fear
DISCRIMINATION: is the opposite of generalization. If the child is exposed to a different
setup of clinic to those associated with painful experience, the child learns to
discriminate between the two clinics
ACQUISITION : learning a new response from the environment by conditioning
GENERALIZATION : wherein the process of conditioning is evoked by a band of stimuli
centered around a specific conditioned stimulus. Eg, a child who had a painful
experience with a doctor in white coat always associates any doctor in white coat
with pain

99
Classical conditioning causes an originally neutral stimulus to become associated
with one that leads to a specific reaction. If individuals in white coats are the ones
who give painful injections that cause crying, the sight of an individual in a white
coat soon may provoke an outburst of crying

• Classical conditioning occurs readily with young children and can have a
considerable impact on a young child's behavior on the first visit to a dental
office.
• By the time a child is brought for the first visit to a dentist, even if that visit is
at an early age, it is highly likely that he or she will have had many experiences
with pediatricians and medical personnel.
• When a child experiences pain, the reflex reaction is crying and withdrawal.
• In Pavlovian terms, the infliction of pain is an unconditioned stimulus, but a
number of aspects of the setting in which the pain occurs can come to be
associated with this unconditioned stimulus.
• For instance, it is unusual for a child to encounter people who are dressed
entirely in white uniforms or long white coats.
• If the unconditioned stimulus of painful treatment comes to be associated
with the conditioned stimulus of white coats, a child may cry and withdraw
immediately at the first sight of a white-coated dentist or dental assistant.
• In this case, the child has learned to associate the conditioned stimulus of pain
and the unconditioned stimulus of a white-coated adult, and the mere sight of
the white coat is enough to produce the reflex behavior initially associated
with pain.
100

101
Every time they occur, the association between a conditioned and unconditioned
stimulus is strengthened. This process is called reinforcement

• The association between a conditioned and an unconditioned stimulus
is strengthened or reinforced every time they occur together.
• Every time a child is taken to a hospital clinic where something painful
is done, the association between pain and the general atmosphere of
that clinic becomes stronger, as the child becomes more sure of his
conclusion that bad things happen in such a place.
• Conversely, if the association between a conditioned and an
unconditioned stimulus is not reinforced, the association between
them will become less strong, and eventually, the conditioned
response will no longer occur. This phenomenon is referred to as
extinction of the conditioned behavior.
• This is the basis for a “happy visit” to the dentist following a stressful
visit.
• Once a conditioned response has been established, it is necessary to
reinforce it only occasionally to maintain it. If the conditioned
association of pain with the doctor's office is strong, it can take many
visits without unpleasant experiences and pain to extinguish the
associated crying and avoidance.
102

• The opposite of generalization of a conditioned stimulus is
discrimination.
• The conditioned association of white coats with pain can easily be
generalized to any office setting.
• If a child is taken into other office settings that are somewhat
different from the one where painful things happen, a dental office,
for instance, where painful injections are not necessary,
discrimination between the two types of offices soon will develop,
and the generalized response to any office as a place where painful
things occur will be extinguished.
103

Uses of this Principle –
1. Developing good habits
2. Breaking bad habits and elimination of
conditioned fear
3. Psycho-therapy to de-condition emotional
fear
4. Developing positive attitude
5. Teaching alphabets
Merits of Classical Conditioning –
• Simple to understand and very applicable
on a child in a dental clinic
104

OPERANT CONDITIONING
BF Skinner (1938)
• According to this theory, the consequence
of behavior itself acts as a stimulus and
affects future behavior. Behavior that
operates or controls the environment is
called operant.
• It stresses that reinforcement is the critical
factor for learning and therefore for
development of personality.
• The relationship between the operant and
consequences that follows them is called
contingency.
105

It relies on 3 main principles:
– Operant behaviors are voluntary and not a reflexive
response
– Consequence of behavior is itself a stimulus that effects
future behavior
– Behavior shaping – it is building response by reinforcing its
components in a step by step manner
• The basic principle of operant conditioning is that the consequence
of a behavior is in itself a stimulus that can affect future behavior. In
other words, the consequence that follows a response will alter the
probability of that response occurring again in a similar situation.
• In classical conditioning, a stimulus leads to a response; in operant
conditioning, a response becomes a further stimulus.
106

107
Operant conditioning differs from classical conditioning in that the consequence of
a behavior is considered a stimulus for future behavior. This means that the
consequence of any particular response will affect the probability of that response
occurring again in a similar situation

Four Basic Types of Operant Conditioning
POSITIVE REINFORCEMENT :
• If pleasant, consequence follows response.
• Eg. Child given a reward for behaving well during
his/her first dental visit is likely to behave well
during future dental visits.
NEGATIVE REIFORCEMENT :
• Involves removal or withdrawal of unpleasant
stimuli following response.
• Eg. Temper tantrums thrown by child.
108

110
As they leave the pediatric dentist's treatment area, children are allowed to choose
their own reward—positive reinforcement for cooperation

OMISSION (or time-out) :
• Involves removal of pleasant stimulus after a particular
response
• Eg. Favorite toy of a child is taken away who throws
temper tantrums for short time; probability of similar
behavior in future is decreased.
PUNISHMENT :
• Introduction of unpleasant stimulus is presented after a
response; probability of that behavior that prompted
punishment will occur in future.
• Eg. Use of palatal rake in correction of tongue thrusting
habit.
111

• In general, positive and negative
reinforcement are the most suitable
types of operant conditioning for use in
the dental office, particularly for
motivating orthodontic patients who
must cooperate at home even more
than in the dental office.
• Both types of reinforcement increase
the likelihood of a particular behavior
recurring, rather than attempting to
suppress a behavior as punishment and
omission do.
• Simply praising a child for desirable
behavior produces positive
reinforcement, and additional positive
reinforcement can be achieved by
presenting some tangible reward.
114

Merits of Operant Conditioning –
• Applicable on children who are difficult to manage
• Useful in instillation of life-long positive behavior in a child
dental patient
Demerits of Operant Conditioning –
• Overemphasis on use of negative reinforcement and
punishment in dental clinic
116

• Maslow’s ideas about deficiency motivation were part of his more
general view of human behavior as reflecting a hierarchy of needs, or
motives.
• Needs at the lowest level of the hierarchy, he said, must be at least
partially satisfied before people can be motivated by higher-level
goals.
• Motivation arises from needs.
• When one need is satisfied another higher level of need emerges –
lower level of need does not act as a motivator.
• People deprived of lower needs may defend themselves by violent
means – this behavior is not because they enjoy doing so.
• Some Needs Take Precedence Over Others. Eg, If a person is hungry
and thirsty – one tends to take care of thirst first.
HIERARCHY OF NEEDS
Abraham Maslow (1970)
117

Motivational Conflicts (Miller, 1959)
119

 Parental psychology and attitude is based on hierarchy and
their socio-economical status and their behavior in the dental
clinic.
General Applications –
• Most people in the midst of motivational conflicts are tense,
irritable, and more vulnerable than usual to physical and
psychological problems.
• Even after a conflict is resolved, stress responses may
continue in the form of anxiety about the wisdom of the
decision or self-blame over bad choices. These and other
consequences of conflicting motives can even lead to
depression or other serious psychological disorders.
120

SOCIAL COGNITIVE LEARNING THEORY
Albert Bandura (1963)
• Bandura does not consider himself a
Social Learning Theorist, but prefers
Social Cognitive Theory
• Comprehensive theory that includes
motivational and self-regulatory
mechanisms
• Emphasizes the social origins of
human thought process and behavior
• Emphasizes cognitive influence on
behavior, rather than conditioning
influences from the environment
121

Bandura’s Theory
• Human beings have specific abilities
related to learning that sets them
apart from other species.
• Social cognitive theory states that
there are three characteristics that
are unique to humans:
 Vicarious consequences (model
and imitate others)
 Self–efficacy (self reflection)
 Performance standards and
moral conduct (ability to regulate
one’s own behavior)
122

• Bandura believed that a person’s level of motivation is an
affective state and actions are based more on what they
believe. Bandura believed that motives included:
– past reinforcement or more traditional behaviorism
– the promise of reinforcement or incentives
– and also vicarious reinforcement or modeling.
• These beliefs define what is learned.
• According to Bandura, in order to learn, one must
– pay attention
– be able to retain or remember
– have the ability to reproduce the behavior
– motivational process
123

• In his social-cognitive theory, Albert Bandura (1999; 2006) sees
personality as shaped by the ways in which thoughts, behavior, and
the environment interact and influence one another.
• He points out that whether people learn through direct experience
with rewards and punishments or through the observational
learning processes, their behavior creates changes in their
environment.
• Observing these changes, in turn, affects how they think, which
then affects their behavior, and so on in a constant web of mutual
influence that Bandura calls reciprocal determinism.
124

• According to Bandura, an especially important cognitive element in
this web of influence is perceived —the learned expectation of
success.
• Bandura says that what we do, and what we try to do, is largely
controlled by our perceptions or beliefs about our chances of
success at a particular task or problem.
• The higher our perceived self-efficacy in relation to a particular
situation or task, the greater our actual accomplishments in that
situation or task (Zimmerman & Schunk, 2003).
• So going into a job interview with the belief that you have the skills
necessary to be hired may lead to behaviors that help you get the
job.
• Perceived self-efficacy about a specific behavior can interact with a
person’s expectancies about the consequences of behavior in
general, thus helping to shape the person’s psychological well-
being.
126

• For example, if a person has low perceived self-efficacy and also
expects that nothing anyone does has much effect on the world,
the result may be apathy.
• But if a person with low perceived self-efficacy also believes that
other people are enjoying the benefits of their efforts, the result
may be self-criticism and depression.
127

The Bobo Doll Study
• Albert Bandura’s Bobo doll study in 1961 was a
classic study that demonstrates the social
learning theory. The study showed that after
viewing adults strike and kick a Bobo doll,
children would imitate the behavior in another
environment. This was important, as it suggests
that the violence could be imitated by viewers.
• Results showed that 88% of the children imitated
aggressive behavior following the viewing of the
tape of adults acting aggressively toward the doll.
• 8 months later, 40% of the same children
reproduced the violent behavior observed in the
Bobo doll experiment.
128

Clinical Implications –
• Behavior shaping – allows child to observe individuals who
show appropriate behavior in particular situation.
• Mother’s attitude towards dental t/t – best predictor how a
child will be during dental t/t is to see how anxious the mother
is!
Merits of Social Learning Theory –
• Less reductionistic
• Provides more explanatory concepts
• Encompasses a wider ranger of phenomena
Demerits –
• Based only on observation of behavior of a person with
overemphasis on the role of the environment
129

MARGARET MAHLER’S THEORY OF
DEVELOPMENT (1933)
• Categorizes early childhood object relations to understand
personality development
• Period of childhood divided into various stages –
 Normal Autistic Phase (0-1 year)
 Normal Symbiotic Phase (3 weeks – 5 months)
 Separation-Individualization Phase (5 – 36 months)
Differentiation
Practicing Period
Reapproachment
Consolidation and Object Constancy
130

I) Normal Autistic Phase :
• State of half sleep and half wakefulness
• Achievement of equilibrium
II) Normal Symbiotic Phase :
• Child slightly aware of caretaker
• Smiling response to caretaker
III) Separation-Individualization Phase :
a. Differentiation (5-10 months):
 Exploration of mother – jewelry she wears
 Characteristic anxiety at this period is stranger anxiety
 He/she differentiates between self and other
131

b. Practicing Period (10-16 months):
 Baby physically leaves mother – crawling, climbing. Separation
anxiety is present as the child still requires his mother for safety
c. Reapproachment (16 – 24 months):
 Sense of a separate being
 Child tries to overcome this by showing mother his newly
acquired skills
 Temper tantrums are common
 Reapproachment arises as the child want to be soothed by his
mother but is unable to take her help
d. Consolidation and Object Constancy (24 – 36 months):
 Child is able to cope in absence of the mother
 Child develops an improved sense of time and can tolerate delay
132

Merits of this theory –
 Can be applied to children
Demerits –
 Not a very comprehensive theory
133

OBSERVATIONAL LEARNING / MODELING
• This type of learning appears to be distinct from learning by either
classical or operant conditioning.
• Acquisition of behavior through imitation of the behavior of others,
of course, is entirely compatible with both classical and operant
conditioning.
• Some theorists emphasize the importance of learning by imitation
in a social context, whereas others, especially Skinner and his
followers, argue that conditioning is more important, although
recognizing that learning by imitation can occur.
• It certainly seems that much of a child's behavior in a dental office
can be learned from observing siblings, other children, or even
parents.
134

• There are two distinct stages in observational learning: acquisition
of the behavior by observing it and the actual performance of that
behavior.
• A child can observe many behaviors and thereby acquire the
potential to perform them, without immediately demonstrating or
performing that behavior.
• Children are capable of acquiring almost any behavior that they
observe closely and that is not too complex for them to perform at
their level of physical development.
• A child is exposed to a tremendous range of possible behaviors,
most of which he/she acquires even though the behavior may not
be expressed immediately or ever.
135

• Whether a child will actually perform an acquired behavior depends
on several factors.
• Important among these are the characteristics of the role model.
• If the model is liked or respected, the child is more likely to imitate
him or her.
• For this reason, a parent or older sibling is often the object of
imitation by the child.
• For children in the elementary and junior high school age groups,
peers within their own age group or individuals slightly older are
increasingly important role models, while the influence of parents
and older siblings decreases.
• For adolescents, the peer group is the major source of role models.
136

• Another important influence on whether a behavior is performed is
the expected consequences of the behavior.
• If a child observes an older sibling refuse to obey his father's
command and then sees punishment follow this refusal, he is less
likely to defy the father on a future occasion, but he probably still
has acquired the behavior, and if he should become defiant, is likely
to stage it in a similar way.
• Observational learning can be an important tool in management of
dental treatment. If a young child observes an older sibling
undergoing dental treatment without complaint or uncooperative
behavior, he or she is likely to imitate this behavior.
• If the older sibling is observed being rewarded, the younger child
will also expect a reward for behaving well. Because the parent is an
important role model for a young child, the mother's attitude
toward dental treatment is likely to influence the child's approach.
137

138
The orthodontic treatment room in the pediatric dentistry-orthodontic office, with
three chairs in an open treatment area. This has the advantage of allowing
observational learning for the patients

CONCLUSION
• Important to know about stages of physical,
emotional, psychological development of the
child
• Behavior shaping can be done in accordance
with the expectations of the dentist or the
orthodontist
139

Stages of child development and theories of psychological development

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