Taming the child's psychology via various theories of learning as applicable in pediatric dentistry.

1. CHILD PSYCHOLOGY
Dr. Balraj Shukla

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QUICK RECAP
SIGMUND FREUD
Psychic Triad
Erogenous zones
Psychosexual stages
ERIK ERIKSON
Psychosocial development
Developmental tasks
Psychological crisis
JEAN PIAGET
Cognitive Development
Thinking and Internal Stimuli
Logical Reasoning
Dr. Balraj Shukla

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CONTENTS
LEARNING
MODES OF LEARNING
THEORIES OF LEARNING
- The Psychologist
- The Theory
- Dental application/Pediatric Viewpoint
- Critical Evaluation
Dr. Balraj Shukla

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LEARNING
• Learning is the process of acquiring new understanding, knowledge,
behaviours, skills, values, attitudes and preferences. (Psychology: The
Science of Mind and Behaviour, Richard Gross)
• Learning is defined as relatively permanent change in the behaviour
that occurs as a result of experience. (Organizational Behaviour,
Stephen Robbins)
Dr. Balraj Shukla

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MODES OF LEARNING
• According to Benjamin Bloom (Theory of Mastery
Learning), Learning comprises of three
components:
- COGNITIVE: Analysing, calculating, assessing, etc.
- PSYCHOMOTOR: Performing, Implying, etc.
- AFFECTIVE: Emotional linkage
• Learning can be
- Non-Associative: Habituation, Sensitization
- Active: Self-learning through experiences
- Associative: Learning based on conditions, stimuli & reflexes
Dr. Balraj Shukla

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THEORIES OF LEARNING
Ivan Pavlov (1927) - Classical conditioning
Skinner BF (1938) - Operant conditioning
Abraham Maslow(1954) - Hierarchy of needs
Albert Bandura (1963) - Social learning theory
OTHER:
Margaret Mahler (1975) – Separation-Individuation Theory
Urie Bronfenbrenner (1979) – Ecological Systems Theory
Dr. Balraj Shukla

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IVAN PAVLOV
• Born in 1849, eldest of eleven children
• Sustained a fatal injury in childhood
• Began formal education at 11 years
• Showed interest in research in physiology
• Won the Nobel Prize in Physiology/Medicine in 1904
• 1921-1936 gave his views on psychology in “Wednesday
Meetings” in his laboratory
• Died of double pneumonia at 86.
Dr. Balraj Shukla

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STIMULI & RESPONSE
A stimuli is an object or event that elicits a sensory or behavioural
response in an organism.
A response that is reinforced becomes conditioned.
Unconditioned stimulus: Event that naturally triggers a response
(inherent)
Unconditioned response: Response that is unlearned
Conditioned stimulus: Previously neutral stimulus that is combined
with an unconditioned stimulus
Conditioned response: Learned reaction to a previously neutral
stimulusDr. Balraj Shukla

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CLASSICAL CONDITIONING
Learning mode: Association
Reason: Process of associating one
stimulus with other
Principles:
ACQUISITION (conversion of NS into
CS)
GENERALIZATION
EXTINCTION
DISCRIMINATION
Dr. Balraj Shukla

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CLASSICAL CONDITIONING
Principles:
ACQUISITION
GENERALIZATION
EXTINCTION
DISCRIMINATION
Pain on injection
White Coat Fear
NS
US
UR
CS
CR
Dr. Balraj Shukla

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CLASSICAL CONDITIONING
Principles:
ACQUISITION
GENERALIZATION
EXTINCTION (CS ≠ CR)
DISCRIMINATION
White Coat Fear
CS
CR
Dr. Balraj Shukla

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CLASSICAL CONDITIONING
Principles:
ACQUISITION
GENERALIZATION
EXTINCTION
DISCRIMINATION (CS1 ≠ CS2)
Dr. Balraj Shukla

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Pediatric Viewpoint
• Developing good habits
• Breaking habits and elimination of conditioned stimulus
• Psychotherapy
• Developing positive attitude
• Teaching oral hygiene
Dr. Balraj Shukla

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BF SKINNER
• Born in 1904 in USA
• Lost his younger brother at the age of 16
• Became an atheist
• Wrote an unpublished book called “Dark Years” which he wrote
while living with his parents
• In 1926, he made the Skinner Box
• John B. Watson’s work on psychology attracted him towards the
field
• He died in 1990 due to leukemia.
Dr. Balraj Shukla

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OPERANT CONDITIONING
• Based on: Edward Thorndike’s Law of Effect (1898) – Pleasant consequences lead to
repetition of a behaviour, unpleasant consequences might not lead to repetition of
behaviour.
• Operant: Behaviour that operates or controls the environment
• Extension of classical conditioning
• In this theory, a response leads to further stimulus. The CONSEQUENCE of behaviour
itself acts as a stimulus and affects FUTURE BEHAVIOUR.
• Contingency: Relationship between operant and consequences
Dr. Balraj Shukla

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THE SKINNER BOX
POSITIVE REINFORCEMENT
Rat kept in box accidentally
knocks of a lever (operant)
Food pellet dispensed
(reward)
Rat learns the association
between food and lever
NEGATIVE REINFORCEMENT
Electric Current passed
through the box (operant)
Rat accidentally knocks the
level
Flow of current stops
(reward)
Dr. Balraj Shukla

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OPERANT CONDITIONING
Reinforce: Strengthen or support an
existing idea or feeling
Types of reinforcers:
Unlearned
Tokens
Activities
Social
Dr. Balraj Shukla

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OPERANT CONDITIONING
Reinforcement
Aversive Learning
Positive Negative
Omission Punishment
Dr. Balraj Shukla

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Pediatric Viewpoint
Reinforcements are the most suitable operants
used in the dental office.
Aversive approaches should be controlled
cautiously. E.g. Omission by sending a child’s
parent away might result in unexpected behaviour
from the child
Voice control is the mildest and the most effective
mode of ‘punishment.’
Stimulus
Consequence
Response
Dr. Balraj Shukla

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PAVLOV vs SKINNER
CLASSICAL OPERANT
Involuntary actions lead to an affected
behaviour
Voluntary actions lead to an affected behaviour
Unconditioned and conditioned stimuli are
PRESENTED to the organism
Reinforcement and Punishment are PRODUCED
by the organism
Behaviour frequency is elicited Behaviour frequency is controlled by the
organism itself
Stimuli absent, behaviour absent Stimuli absent, behaviour present
LEARNING: Passive LEARNING: Active
Dr. Balraj Shukla

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ALBERT BANDURA
• Born to Ukrainian-Polish parents in 1925
• Had limited education & hence was self-motivated for learning
• In high school, after being exposed to gambling and drinking he
became interested in human psychopathology
• Became a USA citizen in 1956
• Was one of the first researchers to challenge psychoanalysis and
focus on observational learning
Dr. Balraj Shukla

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SOCIAL LEARNING THEORY
According to Bandura, Reinforcement is a regulator of behaviour
and not a learning technique.
SOCIAL LEARNING THEORY = Modeling + Reinforcement
Learning is a triad of Behaviour, Personal factors and
Environmental factors (Triadic Reciprocal Causation, 1997)
PRINCIPLES:
ANTECEDENT DETERMINANTS
CONSEQUENT DETERMINANTS
MODELING
SELF-REGULATION
Dr. Balraj Shukla

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SOCIAL LEARNING THEORY
ANTECEDENT DETERMINANTS
Something needs to exist previously
for a behaviour to be conditioned.
CONSEQUENT DETERMINANTS
Person’s perception and
expectancy determine behaviour.
A friend conversing with another friend regarding his dental visit. The
conversation is the antecedent for the friend who is yet to visit the dentist. The
way he perceives his friend’s experience is his consequent determinant.
Dr. Balraj Shukla

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SOCIAL LEARNING THEORY
MODELING: Attention + Retention + Production + Motivation
ATTENTION
How long a person observes another
person’s behaviour.
RETENTION
Retaining the observed behaviour of
another person in memory.
Dr. Balraj Shukla

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SOCIAL LEARNING THEORY
MODELING: Attention + Retention + Production + Motivation
PRODUCTION
Actually perform the observed
behaviour
MOTIVATION
Reinforcing what an individual has
learned by observation
Dr. Balraj Shukla

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Pediatric Viewpoint
A child’s behaviour will depend on how he/she perceives the relation between motive, action
and consequence.
For example, modeling in dentistry sees a child observing another child receiving dental
treatment for better oral hygiene and eventually getting a reward for the treatment.
Dr. Balraj Shukla

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SOCIAL LEARNING THEORY
CRITICAL EVALUATION OF THE THEORY
• Less complex to understand
• Explain concepts in a better way
• Encompasses a broader range of phenomena
• Emphasis on external environment & observation which
varies in each individual
• Learning does not necessarily lead to behaviour change
Dr. Balraj Shukla

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ABRAHAM MASLOW
• Born in 1908 to parents who were poor and not intellectual
• Unhealthy relationship with his mother
• Studied psychology after dropping from legal studies (law)
• Married his first cousin in 1928
• Horrors of the World War inspired him to study human
psychology
• Pioneered the discipline of Humanistic Psychology
• In the 1940s he began his work on self-actualization
• Died in 1970 due to a heart attack
Dr. Balraj Shukla

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HIERARCHY OF NEEDS
Level 1: Physiologic Needs
Food, water, sleep, clothing, necessary for survival
If not fulfilled: Sickness, Irritation, Pain or Death
Level 2: Safety Needs
Physical and Psychological Safety
Protection (security), Stability (home), Pain avoidance
(health)
Level 3: Love and Belonging Needs
Social needs like affection, acceptance from parents and
loved ones
Dr. Balraj Shukla

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HIERARCHY OF NEEDS
Level 4: Esteem Needs
To respects one’s own self and respect other humans too.
Independent, Openness and desire to be appreciated for
achievements.
Level 5: Self-actualization needs
Very few people reach this stage where a person finds
his/her passion or mission
Dr. Balraj Shukla

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HIERARCHY OF NEEDS
CRITICAL EVALUATION OF THE THEORY
• Emphasis on self-actualization which helps in realizing the need to
understand the totality of a person.
• Motivation is constantly required and never-ending
• Helps in understanding the social background of a child
• Pain avoidance, tension reduction and pleasure act as sources of
motivating behaviour
• No relevant dental application apart from parental attitudes
Dr. Balraj Shukla

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MARGARET MAHLER
• Born in 1897 in Hungary to parents who had a troubled marriage
• Being a Jew, her education was interrupted often
• She turned from paediatrics to psychiatry to analysis.
• Ended up being a psychoanalyst for troubled children.
• Moved to Britain in 1936 because of tension against Jews.
• Settled in New York in 1938.
• Developed a Tripartite Treatment Model where the mother had a role in
treatment of the child. She believed that love and play are central to child
development.
• Died in 1985.
Dr. Balraj Shukla

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SEPARATION-INDIVIDUATION THEORY
Principle: Early childhood object relations for personality development
NORMAL AUTISTIC PHASE (0-1 year)
- Half-asleep, half-awake
- Equilibrium with the environment
NORMAL SYMBIOTIC PHASE (3-4 weeks
to 4-5 months)
- Infant is aware of caretaker but
cannot differentiate himself/herself
from anyone else
Dr. Balraj Shukla

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SEPARATION-INDIVIDUATION THEORY
SEPARATION-INDIVIDUATION (5-36 months)
- DIFFERENTIATION/HATCHING (5-10 months)
Infant learns to differentiate between him/her and the mother. More alertness to outside world
(STRANGER ANXIETY)
- PRACTICING PERIOD (10-16 months)
Exploration, ability to crawls, first instances of distancing from the mother (SEPARATION
ANXIETY)
- RAPPROACHMENT (16-24 months)
Experiences praise (acquisition of new skills) and punishment (temper tantrums).
- CONSOLIDATION & OBJECT CONSTANCY (24-36 months)
Maternal image is now intrapsychic and the child feels comfortable even in mother’s absence
Dr. Balraj Shukla

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SEPARATION-INDIVIDUATION THEORY
CRITICAL EVALUATION OF THE THEORY
• Theory was given based on observational data
• Can be applied to children of limited age group
• Dental application limited
Dr. Balraj Shukla

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URIE BRONFENBRENNER
• 1917 - Russian-born American Psychologist
• Moved to the United States and lived with his family in
a rural area at the age of 7
• Bachelor’s in Psychology & Music
• Doctorate in Developmental Psychology
• Psychologist for the U.S. Military in World War II
• Worked on the impact of social forces on child
development in the 1970s
• Died due to diabetic complications in 2005
Dr. Balraj Shukla

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Source: (Berger, 2007)
This theory focuses
on personality
development of a
child based on his/her
surroundings.
The development of
the child is directly
related to what
he/she LEARNS from
his/her external
environment.
Dr. Balraj Shukla

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CONCLUSION
The theoretical basis of learning may or may not be applied at a
generalized level. It should be noted that genetic, biologic and social
changes differ in each individual that directly affects the way an
infant, child or adult learns or observe.
In pediatric dentistry, theories of learning help us in gaining an insight
on how a child can be made comfortable and managed in the dental
operatory. These learning mechanisms when coupled with behaviour
management techniques can play a key role in the treatment of a
child.
Dr. Balraj Shukla

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REFERENCES
• Major theories and models of learning | Educational Psychology. Lumen Learning
• Stanger N. (2011). Moving “eco” back into socio-ecological models: A proposal to reorient
ecological literacy into human developmental models and school systems. Human Ecology
Review. 18. 167-173.
• Cherry, K. (2020). How Learning Theories in Psychology Compare. Retrieved 10 January
2021, from https://www.verywellmind.com/learning-theories-in-psychology-an-overview-
2795082
• Koch G., Polsen S., Espelid I., Haubek D. (2017). Pediatric Dentistry – A Clinical Approach (3rd
edition). John Wiley & Sons Ltd. Chichester.
Dr. Balraj Shukla

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REFERENCES
• Profitt W., Fields H., Larson B., Sarver D. (2007) Contemporary Orthodontics. Mosby
Elsevier.
• Tandon S. (2018). Paediatric Dentistry (3rd edition). New Delhi. Paras Medical Publishers.
• Marwah N. (2019). Textbook of Pediatric Dentistry (4th edition). New Delhi. Jaypee
Brothers Medical Publishers.
Dr. Balraj Shukla