CHILD PSYCHOLOGY

Psychology The word Psychology is made of two ancient Greek words psyche meaning soul and logos meaning word. Thus, Psychology pertains to the study of mind, thought, and behaviour. Child psychology: It is the science that deals with the mental power or an interaction between conscious and subconscious elements in a child .

 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 behavior.

These changes are governed by genetic, familial, cultural , interpersonal and inter psychic factors.

IMPORTANCE
To understand a child better To know the problem of psychological origin To deliver dental services in an effective and meaningful manner To establish effective communication with parent and child To gain confidence of the child and parent To have a better treatment planning and interaction . To produce a comfortable environment for working on the patient.

THEORIES:
Psychodynamic theories

Behavioral theories

Behavioral theories:
Hierarchy of needs Masler

Social learning-Bandura
Classical conditioning Pavlov Operant conditioning - Skinner

Psychoanalytical theory [1905] Given by Sigmond freud

According to this theory behavior is modified by instinctive needs and sexual behavior .
It is composed of 3 major parts-

1) Theory of the structure of personality 2)Theory of personality dynamics 3) Theory of psychosexual development
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1 . Theory of structure of personality: Includes id, ego and superego ID It is the basic structure of personality which serves as a reservoir of instincts
Present at birth, impulse ridden and strives for

immediate pleasure and gratification ,examplehunger, thirst and especially to be sexually stimulated.

EGO It is governed by reality principle.

It is developed after birth ,in 2nd to 6th month of life ,expands with age and it delays ,modify and control ID impulses on a realistic level . It consists of elaborated ways of behaving and thinking which constitute the executive function of the person. The ego delays satisfying the id and channels behavior into more socially acceptable outlets.
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SUPER EGO It acts as sensor of acceptability of thoughts , feelings and behavior

It is determined by regulation imposed upon

child by parent , society and culture

It is the internalized control which produces

the feeling of shame and guilt

It controls Id and ego.
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2. Theory of personality dynamics Freud stated that all these 3 parts have effects on each other and this interplay will decide the final outcome and have its effects on personality of a person.
In this interplay, ego acts as mediator between the id- with its blind demands for instant gratificationand the superego-with its rigid, often irrational

rules, prohibitions and ideals.

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 Apart from this Freud also explained level of consciousness- conscious, preconscious and unconscious.
At the conscious level, we are aware of certain

things around us and of certain thoughts.

At the preconscious level, are memories or

thoughts that are easily available with a moments reflection- for eg. What we had for breakfast or our parents first name.
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 In contrast, the unconscious level contains

memories,thoughts and motives which cannot be easily called up.

All the id is unconscious; the ego and superego

include material at all 3 levels of consciousness.

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ICEBERG CONCEPT OF FREUD

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3. Theory of psychosexual development (Freud stages of development) Oral Anal Phalic Latency Genital

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ORAL PHASE: 0-1 YR OF AGE Oral cavity serves as erogenous zone

Satisfaction of oral desire Dependant stage since infant is dependant on

adult for getting his oral needs fulfilled .

Objective: Develop trust , when his basic needs are

fulfilled
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ANAL PHASE 1-3 yr of age Maturation of neuromuscular control occurs .

Control over sphincters particularly anal sphincters results in increased voluntary activity . In our society, toilet training is ordinarily the childs first encounter with authority and the first time the id must be brought under control of the emerging ego.
There is development of sense of independence and autonomy.
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PHALIC PHASE: In 3-5 yr age group Freud believed that genitals become the major focus of sexual excitement in the phalic stage.
Characterized by :
Oedipus complex
Electra complex

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Oedipus complex It is the tendency of young boy child being attached more towards mother than father. Electra complex It is the tendency of the young girl developing an attraction towards father .

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LATENCY PHASE: 7-11 yrs Resolution of any defect

Phase ends in puberty Ego maturation takes place

Characteristic: child gain better sense of initiative and starts adapting to the adverse environment
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Objective: Further development of personality Pathology: Lack of inner control of or excessive inner control result in a pathological trait like decrease development of skills

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GENITAL PHASEFrom 11- 13 yrs onwards Sense of identification develops

Matured personality
Sense of reproduction and survival

Objective: -Helps to separate from the dependence on parents.

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Social and behavioral development 1) Development of learning. Classical conditioning by PAVLOV . Operant conditoning by SKINNER 2) Emotional development.Eriksons stages of development 3) Cognitive development.Piagets stages of development

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Classical conditioning [Pavlov, 1927] Based on stimulus response reflex

It was developed through experiments with dogs
When 2 stimuli occur together at the same time

resulting in a response , this response can also be obtained by stimulating any one of the original stimuli .

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Principles involved in the process are Acquisition: learning a new response from the environment by conditioning.
Generalisation: wherein the process of conditioning is

evoked by a band of stimuli centered around a specific conditioned stimulus . Eg. a child who has a had a painful experience with a doctor in a white coat always associates any doctor in white coat with pain.

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 Extinction:

-The conditioned behavior results if the association between the conditioned and unconditioned response is not reinforced . Eg. In the above mentioned example subsequent visits to the doctor without any unpleasant experiences results in extinction of fear.
Discrimation-

- It is the opposite of generalization. - If a child is exposed to clinic settings which are different to those associated with the painful experiences, the child learns to discriminate between the two clinics and even the generalized response to any office will be extinguished. 26

Principle of classical conditioning can be used in Developing good habits

Breaking habits Elimination of conditional fear

Developing positive attitudes

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Operant conditioning [Skinner,1938] According to this theory , consequence of behavior itself acts as a stimulus and affects future behavior .
Since behavior acts upon the environment it is

called as an operant .

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Four basic types Positive reinforcement:-occur if a pleasant consequence follows the response, eg. A child rewarded for good behavior following dental treatment.
Negative reinforcement:-involves removal of an unpleasant stimuli following a response , eg. If the parent gives in to the temper tantrums thrown by the child, he reinforces this behavior.

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 Omission: refers to removal of the unpleasant response after a particular response, eg. If the child

misbehaves during the dental procedure, his favourite toy is taken away for a short time resulting in the omission of the undesirable behavior.
Punishment :involve introduction of an aversive stimulus into a situation to decrease the undesirable behavior, eg. Use of palatal rake in correction of tongue thrusting habit.

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Psychosocial theory
In 1963, given by Eric erikson

Modified freuds theory

Postulates that society responds to the childs

basic needs or developmental tasks .

Described into 8 stages ,5 during childhood and

adolescence, rest 3 in later part of life .

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Stages :Basic trust versus mistrust [0-12 month] -Basic needs are met by the person whom he trusts,when these are not met he develops mistrust.
So if necessary to provide dental treatment at this

early age, it is preferable to do with the parent present and preferably with parent holding the child.

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 Autonomy versus shame, doubt[2-3yrs]

A time of gaining mastery over issues of self control

far beyond bowel and bladder control Failure leads to doubt or shame Principle anxiety is loss of love and fear of separation during this period. At this stage as the child takes pleasure in doing tasks by himself; dentist must obtain co-operation from him by making him believe that the treatment is his choice not of the dentist/parent.

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 Initiative versus guilt[4-5 yrs]

Child deals with issue of curiosity about the anatomic

differences between the sexes ,body integrity and gender identity. Primary fear is of bodily injury.

Industry versus inferiority [6-12 yrs]-Mastery over academic achievements integration into the world of children
-Child become industrious -Failure leads to sense of inferiority.

and

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 Identity versus role confusion[13-18yrs] - period of adolescence - Mental and physiological maturation is present - Impatient ,idealistic , who believes that it is easy to realize a ideal as it is to imagine it - Consolidation of sense of achievement - Importance of parents is more direct . - Eg. Any orthodontic treatment should be carried out if child wants it and not parents as at this stage, parental authority is being rejected.

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 Intimacy vs role confusion

19-25 yr Adult realizes the need for one truly intimate

relationship .
Generativity vs stagnation

26-50 yr
Adult rears children or performs creative act

failing which stagnation occurs .

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Ego Integrity vs Despair: Above 50 yr

Adult integrates earlier stages and achieves sense

of integrity .

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COGNITIVE THEORY Jean Piaget, 1952 He emphasized that childhood development proceeds from an egocentric position through a predictable , step like consistent expansion by incorporation of learned experiences. Sequence of development has been categorized into 4 major stages: Sensorimotor stage[ 0-18 months] Preoperational period[18months-7yrs] Period of concrete operations[7-12yrs] Formal operation periods[12-18yrs]
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Sensorimotor stage[ 0-18 months]: Learn to interrelate the sensory modalities and able to look forward and reach for an objectives,desires .
The child does not yet have the capacity to represent objects or people to himself, that is, out of sight, out of mind. As maturation progresses the simple reflexes begin to be coordinated, eg. Looking along with arm movements resulting in hand watching.

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 Pre operational period:

[18months-7yrs]

It is a transitional period from the sensorimotor

period to period of concrete operation . Concept of time,number and logical order acquired Uses symbols in language and play

Learns to classify things

Solves the problem ,but cannot explain.
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 Constructivism the child likes to explore things and make own observations, eg. Child surveys the dental chair, airway syringe.
Animism eg. Explaining about radiograph as

tooth picture.

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Period of concrete operation [7-12yrs]: Thinking process becomes logical

Develop the ability to solve complex mental operations

as addition and subtraction

Able to understand other point of views . Centering- allowed to hold the mirror to see what is

being done on his teeth.

Ego- centerism: child has achieved the level of

understanding and gets involved in the treatment, eg. 42 Holds the suction tip by himself.

Formal operational period[12-18yrs]: Logical operation abstract thinking and hypothetical reasoning.
He can consider a hypothetical situation.
Uses inductive or deductive logic to make decisions

and solve problems.

Peer influence and abstract thinking increase.

- This can play an important role in orthodontic appliances and braces.

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Hierarchy of needs [Masler ,1954]: Self actualisation theory

This theory explains personality development

based on individual priority of needs and motivation .

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 Level1-physiologic needs [hunger ,thirst] Level 2- security [ need for shelter and

employment] Level 3 social [need to be loved and have a sense of belonging] Level 4- esteem [competency and skills needs, to feel wanted] Level 5 self actualization [ realization of self] .Lower levels of needs have to be fulfilled for the functioning of higher level of needs .
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Social learning theory [Bandura, 1963]: Principle of this theory is that behavior is learned by reinforcement.
The infant quickly learn in a reflexive manner that certain behavior on his part elicit response from his parents . If these responses are rewarding and pleasing to the child , the initial behavior will be repeated over and over and eventually become a part of his behavior and personality .
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 The learning of behavior is affected by four

principal elements: 1) Antecedent determinants- the conditioning is affected if the person is aware of what is occuring. 2) Consequent determinants- persons perception and expectancy determine behavior. 3) Modeling learning through observation eliminates the trial- error search. . It is not an automatic process but requires cognitive factors and involves 4 processes which are:
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- Attentional processes - Retention processes - Reproduction processes - Motivational processes 4) Self regulation this system involves a process of self- regulation, judgement and evaluation of individuals responses to his own behavior. .eg. If a young child observes an older sibling undergoing dental treatment without complaint, he/she is likely to imitate this behavior.
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THANKS

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