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CHILD PSYCHOLOGY Children are not small adults but developing individuals during childhood, the child undergoes a remarkable transformation from a helper, dependent infant to independent, self-sufficient individual with her own views and outlooks, capable of earbarking on a career and living separately from a family. Psychologic growth and development generally proceed in a relatively predictable, logical, step-like sequential order. These processes are influenced by genetic, familial-cultural, inter-personal and intrasychic factors. An understanding of these tasks to specific age groups will equip the dentist with the knowledge of the particular needs fears of children and adolescents. Therefore, knowledge of normal psycholiogic growth and development is essential to the practice of modern dentistry. The child’s development should be always viewed in psychologic, social, cognitive and physical terms, to ignore any one of these is to exclude an integral part of the wide child. Many theories have been proposed to explain and identify the process involved in personality development. Although these theories are treated separately there are similarities, which allow for comparison.

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Definition : Psychology is that branch of science which deals with mind and mental processes especially in relation to human and animal behaviour. Behaviour – The manner in which a person acts. Thomson in 1912 first time gave the development pain, anxiety. Theories of psychology can be broadly given into: I] a. Stage theories

Psychoanalytic Psychosexual Cognitive theory

b. Non-stage theories Social learning theory II] a.

Psychodynamic theory (Freud 1935)

Archeic discharge syndrome

Psychoanalytic (Freud 1915) Psychosexual (Freud 1915) Psychosocial (Erik, Eriksson) The theory of hierarchy of needs (Abraham Maslow 1954).

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b.

Behaviour learning theory Classical conditioning theory (Ivan Pavlov 1927). Operant conditioning (Skinner 1938) Cognitive theory (Jean Piaget 1952) Social –learning theory (Albert Bandura 1963) Transactional analysis (Eric Berne 1964) In contrast to this non-stage theories regard development as

continuous rather than stages and no distinction between periods. Psychodynamic theories indicate that the behaviour keeps changing progressively and behaviour learning theories indicate that learning is the key to development of behaviour. Archaic discharge syndrome: According to this body contains two types of neurons : -

phi neurons (for conduction of emotions).

-

psi neurons (for storage of emotions). When stored, emotions reach a certain level, a discharge occurs

to display emotions. Psychoanalytical theory: Stage theories represent stages which are hierarchically organized, so that later stages incorporated remnants of earlier stages. 3


No stage can be skipped and successive stages more complex and integrated than earlier phases. (Sigmund Freud was the founder of modern psychiatry). He put forth the psychoanalytical theory based on three structure to understand the intrapsychic processes and personality development. They are id, ego, seeperego (this forms psychic triad). Id: It represents unregulated instinctual drives and emergeies striving to meet bodily needs and desires and is governed by pleasure principle. Here the person thinks only of body needs and desire but with little concern for other or social convention. Example: Intoxicated, sexually provocative person exclusively acts under pleasure principle. Dreams also provide pleasure because of their unrestricted and uninhibited nature. Ego: Is the seat of consciousness, which exploits that environment to the maximum to achieve gratification in socially acceptable ways. Example: is the utilization of ego defense mechanism and of other ego functions such as memory, language, intelligence and creativity.

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It develops in the 2nd to 6th months of life and is governed by reality principle. It serves as a mediator between id and isuperego. Example : Hunger must wait until someone provides food. Ego acts by (drprris) • Projection : projecting one’s own inadequacy on to someone else to feel more comfortable. Ex: A bad work will be blamed on his tools. • Denial : Denying the existence of threatening situation so as to avoid tackling it. Ex: Rough the tooth pain is severe, pretending as if it is not painful inorder to avoid dentist. This may be of advantageous or even disadvantageous prevents to cope with the anxiety and crisis, individual may not realistically cope-up with life. • Identification – Initiating the qualities of some one else to vent frustration. • Regression : IT is the inappropriate response as a result of confrontation with an anxiety producing situation. Ex: thumb sucking in older children.

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• Repression: It is the process of unconscious forgetting for repression of painful experiences to subconscious mind. • Rationalization : It is the development of logical excuses to explain behaviours. Ex: Refusing to complete because of fear of failure but using some other excuse. • Sublimation : It is the redirection of socially unacceptable drive into socially approved channels to allow the discharge of instinctive impulses in an acceptable form. Ex: Sadist becoming a butcher. Superego: It may be linked to a social coscience. It is that part of personality which is the internalized representation of the values and morals of society as taught to the child by the parents and others. It is derived from the familial, culture restrictions placed upon a growing child. It develops from the internalization of feeling of good and bad, love-hate, praising-forbidding, reward and punishment of both parents. It continues during school age and in fact throughout life based on identification on with important figures such as teacher sports heroes

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etc. If child identifies aggressive, violent parent, it leads to the possibility of uncivilized behaviour. Thus, -

the id seeks pleasure.

-

The ego tests reality.

-

Superego strives for perfection

Psychosexual theory: Freud defined five phases of psychosexual development based on a theory of energy or drives and called as libids. Originally libido represented sexual drive and energy, the definition was later broadened to encompass all the pleasurable activities. He divided the whole personality into five stages and linked to pleasurable erotic body zones. -

Oral

-

Anal

-

Phallic (oedipal)

-

Latency

-

Genital

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Oral stages: 0-1 years Theories of emotional and social development Freud, Erikson and Bowlby) Occurs during the first year of life. The mouth serves as the primary zone of pleasure and the balery gains its most intense pleasure from sucking and mouthing when deprived of adequate mothering, the baby’s behaviour reveals its distress with exaggerated cry, tension and muscle rigidity. When mothering becomes adequate, these acute symptoms often disappear. The major developmental task taking place is weaning. Adult characteristic arising from complete resolution of this stage results in active behaviour such as smoking, drinking, reading. Anal stage (2-3 years) The main feature of this stage is the childs acquisition of voluntary bowel and bladder control. The baby derives pleasure from the process of elimination during the first six months. the increased control of three functions helps gaining cognitive and locomotor skills. Toilet training is the first and prototype cooperative activity seen between child and parent. Ensuring the successful completion of toilet

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training requires adaptability and sensitivity by the parent because of the childs immaturity. Too rigid and too flexible approach is said to influence the childs emerging personality. Incomplete resolution results in adult personality characteristics of untidiness and obsessionality. Phallic stage (3-6 years) Childs libidinal energy is directed towards general activities. Children are now able to discover the genital differences between sexes. During this period, the male child develops and the “oedipal complex” a desire to have sexual relation with the mother. This leads him to perceive his father as a rival for his mothers attention and affection. The little boy adapts his fathers. Manner, attitude and interest so that his father will not hurt him by becoming like his father he hopes to win his mothers love. The boy also fears that his father will retaliate against him by castrating him and this fear is called “castration anxiety”. Similar explanation are applied for girls, sexual conflict and is termed as “electra-complex”. The other prominent feature of this stage is the emergence of jealous and competitive feeling towards peers and siblings.

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The unsatisfactory resolution of this oedipal conflict manifests itself in later life as sexual conflicts are concerning sexual role and identify and also inability to perform intimate sexual relationships. Latency stage: (6-12 years) This period is so called because of its relative tranquility compared with the emotionally stormy periods of the phallic and genital periods. The sexual feelings subside after the resolution of the oedipal complex. The child focuses his attention on the same-sex parent, leading to increased identification with and role modeling on this parent peer group relations are predominately with the same sex. A major feature of this period is the establishment of the ego mechanisms of defense. The important function of the developing ego was to manage the excessive anxiety that arises from the inevitable stressful nature of some childhood experiences. The exposure to stress and anxiety is essential for the child’s well being, as it provides the child with opportunity to learn to cope with unpleasant or distressing feeling. The most common defense mechanisms: Denial – Reluctance to accept the potentially stressful event.

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Rationalization – Attempt to minimize the psychological consequence of the event. Regression – Occurrence of developmentally immature behaviour often at times of stress. Displacement – Transfer of aggressive feelings from their original source to another person, usually less powerful or important. Genital stage: (12 years onwards) The endocrinological and physiological changes at puberty and sexual interest re-emerges and a good outcome of this stage is dependent on the well or otherwise how the individual has dealt with other stages earlier. Two stages the oral and the phallic, are particularly crucial. The poor resolution of the oral phase may preclude the foundation of close, trusting relationships with the opposite sex, whereas unresolved phallic conflicts may lead to confusion over sexual role and behaviour. In addition to the establishment of sexual role, the older adolescent will develop the tasks like separation from parents, career choice and acquisition of own ethical and moral values.] A major criticism of Redudian theory is that its concepts do not lead themselves reacting to empirical or scientific investigation, so that

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it is different to prove or more importantly, disprove the validity of the theory. Psychosocial theory: 1965 Erik Erikson Erikson

modified

Freud’s

theory

by

superimposition

psychosocial and psychosexual factors simultaneously contributing to the personality development of the child. This theory postulates that society responds to the child’s basic needs or developmental tasks in each specific period of life and states that in doing so, society assures not only the childs healthy growth but also the passage of society’s own culture and traditions. His approach emphasize the dependent interaction of individual and society. Trust Versus mistrust (0-1 years) This phase occupies the first year and is mainly concerned with the establishment of secure and stable relationships between mother and child. The successful outcome is there, the child feels that the world is predictable, safe and secure by contrast a basic sense of mistrust implies that the world is cruel, eratic and unable to onact the needs.

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Good outcome – sense, stable relationships. Bad outcome – insecure, unsatisfactory relationships. Anatomy Vs shame, doubt : 2-3 This phase is characterized by the child’s increasing powers of mobility and locomotor skills, providing the basis for the development of some independence and anatomy. The new skills are very vulnerable the child’s self-confidence is easily undermined leading to the negative outcome of shame and doubt. Good outcome – capable and competent. Bad outcome – insecure, unsatisfactory relationships. Initiative Vs guilt (4-5 years) The child rapidly expands the skills part in language, so that exploration and activity the order of the day. If the child’s exuberance and enthusiasm are too restricted by parents or other, then despondency and defeatism predominate, leaving the child with a sense of guilt. Good outcome – confident about skills. Bad outcome – resistant.

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Industry Vs inferiority (6-12 years) Schooling and peer relations predominate in this phase, so that successful child becomes literate, numerate and socially integrated. Failure to achieve this leads to a sense of inferiority and inadequacy with a low self-esteem. Good outcome – literate, numerate and socially integrated. Bad outcome – socially isolated. Identify Vs role confusion (13-18 years) Two tasks, sexual identity and career identity are the major forces of interest for the individual. Independence from the family and developing one’s own value system become important during late adolescence. Good outcome – Suitable career choice and satisfactory leterosexual relationship. Bad outcome – uncertain of career, poor peer relations. Intimacy Vs isolation – 19-25 years Good outcome – stable relationship and good career. Bad outcome – poor intimate relation and career choice.

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Generativity Vs stagnation – 26-40 years: Rear children in stable union. Good outcome – family stability. Bad outcome – unstable relationships. Ego integrity Vs despair – 41+ Life’s success and failure Good outcome – acceptance of life’s limitation. Bad outcome – Despondency and despair. The theory of hierarchy of needs: According to this, the individuals prior of needs and motivation affect the personality development: Level I : Physiologic needs. Needs essential for survival like hunger, thirst, fear. Level II : Security needs: Need for shelter and employment. Level III : Social needs Need to be loved and to have a sense or belonging.

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Level IV : Esteem Need to acquire personal work, competency and skills. Level V : Self-actualization Need to realize oneself. Higher needs are not demonstrated until lower needs are fulfilled

The theory of separation – individuation Mahler asserted that the psychologic development of an individual proceeded in a continually unfolding the process, with critical stages during the first three to four years of life. Initially the infant is biologically and psychologically bound to the mother, the infant has difficulty in distinguishing himself or herself from other. As the infants sensory and motor skills improve he is capable of greater and newer experience with the mother and environment, which fosters a greater awareness of being separated from the mother. The more interactions the infant has with the environment the more the infant learns how to distinguish himself or separate from others, as an individual. The

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interaction between a mother and infant determines how secure and successful the infant is in achieving separation individuation. This forms the basis of relationships with others Behaviour learning theories These theories differ from other theories in that: -

They are not stage theory.

-

They are not solely concerned with childhood but can be applied to all the age groups.

-

They are based on learning theory principles.

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They are a historical in their approach to understand the behaviour i.e. they concentrate on circumstances for explaining behaviour rather than emphasizing the role of previous events or experiences. “Learning is defined as a permanent change in behaviour as a

result of experience�. There are many theories of learning. The important one relevant to child development are

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-

Learning by direct reinforcement

Stimulus contingent (Classical conditioning) Response contingent

-

Learning by initiation.

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Learning by induction.

Learning by direct reinforcement Reinforcement is the presentation or removal of a stimulus after a response which alter the subsequent frequency of that response. This is the central idea underlying this approach to the acquisition or modification of behaviour. a. Classical

conditioning

theory

(Stimulus-contingent

reinforcement) Originally studied by Pavlov An un-conditioned stimulus is presented. Hereby eliciting a reflex unconditioned response. Repeated presentation of the two stimuli leads over time to the establishment of a conditioned response. Ex: Ist visit White coat –

pain or injection.

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(Neutral stimulus)

(Unconditioned stimulus)

Pair or injection –

Fear and Crying

(Unconditioned stimulus) (Response) 2nd visit Sight of white coat

pain of injection

(conditioned stimulus)

(unconditioned stimulus)

Pain of injection

free and crying

(Unconditioned stimulus) (Response) Ex: Food – Salivation food – bell (neutral) – all bell – salivation b. Response – contingent reinforcement theory: (Operant or instrumental conditioning) According to this, individual behaviour is modified or shaped according to the reinforces associated with that behaviour. The strength and persistence of the behaviour of influenced by the schedule or pattern of reinforcement. Ex: When the child is good, mother says he is good child learns to produce good behaviour so as to receive praise from the mother. Skinner described 4 basic types of operant conditioning, distinguished by the nature of the consequence.

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1. Positive reinforcement: If a pleasant consequence follows a response the response has been positively reinforced and the behaviour that lead to this pleasant consequence becomes more likely in the future. Ex: If a child is given a reward such as a toy for behaving well during her first dental visit, she is more likely to behave well during her subsequent dental visits also. Negative reinforcement – contingency It involves the withdrawal of an unpleasant stimulus after a response. Like positive reinforcement it increases the likelihood of a response in the future. Example: A child who views a visit to dental clinic as an unpleasant experience, may throw a temper tantrum. If this behaviour succeeds from escaping the treatment, the behaviour is told to be reinforced. Omission (Time-out): It involves the removal of a stimulus after a particular response.

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Example: If a child who throws a temper trantrum and his favourite is taken away for a short time as a consequence of this behaviour the probability of similar misbehaviour is decreased. Punishment: Occurs when an unpleasant stimulus is presented after a response. This also decreases the probability that behaviour that promoted punishment will occur in the future. Ex: Voice control. Learning by initiation: Learning by observing is a method for altering behaviour. Bandura (1969) showed that modeling of behaviour occurred readily among children in many situations. Two factors influence the acquisition of such behaviour. For ex: a child may observe that a person who greets some one in a friendly situation is usually happy themselves (direct effect) and in turn this behaviour is usually followed by a warm response from child person (indirect effect). This explains in acquisition of more simple behaviour.

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Learning of induction This helps to know the acquisition of more complex and nature social behaviour. This is also called as cognitive – behavioural model. As children nature, their increased cognitive capacity enables them to establish some general principles governing pro-social behaviour. These are triangular to Piagets notion of abstract or formed operation thinking. Cognitive theory: 1929 – Jean Piaget A Swiss psychologist has elaborated the most comprehensive theory of cognitive development. Survival of the fittest and most adaptable is the driving force underlying development. Accordingly, in order to survive, the individual must have the capacity to adapt to the demands of the environment. Cognitive development is the resist of interaction between the individual and the environment.

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Piaget’s major concepts: Adaptation

Assimilation. Accommodation

Equilibration Schema Operations Assimilation: Describes the ability of the child to deal with new situations and problems within his age-specific skills. Ex: systemic desensitization existing learned maladaptive responses by substituting more appropriate ones. Accommodation: Modification of strategy as a result of new experience. Equilibration: The process of balancing assimilation and accommodation. Schema: Internal representation of some specific action present from birth (sucking).

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Operations: Internal cognitive rules that arise later childhood. Piaget describes four main phases of cognitive development. a. Sensorimotor (0-2 year) Schemes b. Pre-operational (2-7year) c. Concrete – operational (7-12 year) Operations d. Formal-operational (12 year and onwards) Sensorimotor : Initially, behaviour is dominated by innate reflexes such as feeding, sucking and following, hence the name for this stage. Gradually the infant realizes the distinction between self and non-self. The infant also realizes that his behaviour can influence the environment, so that intentional and purposeful behaviour begins. Finally, the infant achieves object permanence, (an object still exists even though it is no longer visible).

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Pre-operational period: Langauge development greatly occurs. Thinking in this phase is described as egocentric and animistic. Egocentric refers to the child’s tendency to regard everything in the world as endowed with feeling thoughts and wishes. The child also believes that every event has a preceding cause, rejecting the concept of chance coincidence. Compete operational: Thinking becomes more logical. Conservations of no, volume and mass is successively achieved during this period. The child becomes less egocentric and is capable of seeing events from another persons standpoint. Formal operational: (12 years onwards) This stage represents the most complex mode of thinking. Person has the ability to think, to formulate general laws and principles, to devise and test hypothesis and even an scientific investigation.

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Comment or Piaget’s theory: Though most psychologist accept the Piagetion idea of orderly sequence to cognitive development most research has failed to demonstrate the existence of specific cognitive structures proposed by Piaget for the concrete and formal operational stages. Additionally, Piagetian explanation for the younger child’s inability to solve conservation problems, and also the absence of necessary cognitive structures has been questioned by more recent studies (Lee 1989). They think that the critical factor in the child’s failure solve such problems may be inadequate memory capacity rather than inadequate cognitive ability. Cognitive – Perception of an art distinct from emotions or volition. Volition – Voluantary act (willing). Clinical application It is necessary to assess the child’s behaviour is developmental (age appropriate) or psychopathological (abnormal behaviour). Ex: Separation anxiety is a normal reaction in children between the ages 9 months and 4 years. However if the same response is seen in

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a 6 year old would be abnormal. Similarly temper tantrum in a 3-year old would not be pathological. Child hood psychopathology is most commonly considered under following headings: a. Abnormality of emotions. b. Abnormality of behaviour. c. Abnormality of social relationships. Anxiety and depressive symptoms are important features of emotional disturbances. Anxiety has physical manifestations like palpitation or by month as well as psychological components such as fear or apprehension. Both psychoanalytical and social learning theories explain this psychoanalytical theory describes that the immature child learns to cope with excessive anxiety by adaptive mechanisms. Social learning theories explain anxiety in terms of exposure to situations which become associated with anxiety through classical conditioning or modeling. According psychoanalytical theories, separation anxiety causes the development of depressive responses in later childhood and adult life.

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Modelling theories regard many behavioural problems as arising from the lack of exposure to normal behavioural problems as arising from the lack of exposure to normal behavioural patterns or exposure to deviant models. Treatment for this focuses on exposure and reinforcement of socially approved behaviour. Children with emotional or behavioural problems are usually socially isolated and unpopular with their peer group as they exclude themselves or are excluded as a result of deviant behaviour. The active supervision of the developing dentition is a responsibility of the pedodontists. Seeing things from the beginning is the most advantageous. By making a detailed studies of dentition from initiation through eruption till functional occlusion, we may be able to obtain a clear concept of how occlusion develops and how its development can be guided. Occlusion is the approximation of upper and lower teeth, centric occlusion is the maximum intercuspation between upper and lower teeth centric relation is defined as the contact of teeth (U & L) in most retruded position of the mandible so that condyle is in its most posterior position with respect to glenoid fossa for the maximum comfort of the patient.

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