Index:-IntroductionDefinitions ClassificationPsychodynamic TheoriesBehavior Learning TheoriesConclusion

Introduction:-

The study of the human personality and behavior is one of the most interesting branches of science.

With the developing personality comes the acquisition of the newer skills the power to think and reason, various emotions like fear, anxiety, joy, happiness etc. each of these contributing in its own way to convert the infant into a mature adult.

With age the infant acquires certain skills these are the basic of the human being. Recognition of face, locomotion, speech, motor activity etc. each of these skills is acquired at a specific age. These skills are termed as developmental milestones, which act as indicators of child development.

Definitions:-Psychology:- It can be defined as the branch of the science dealing with the human and animal behavior and related mental processes. A pediatric dentist, in order to carry out the treatment of a child should have an accurate picture of the developmental pattern of the child.Child Psychology:-It is the science or study of the childs mind and how it functions. It is also the science that deals with the mental power or an interaction between the conscious and subconscious elements in a child.

Emotion:- An effective state of consciousness in which joy, sorrow, fear hate, or the likes are expressed.

A feeling or mood manifesting in motor or glandular activity.

Behavior:-

It is any change observed in the functioning of the organism.

Behavior Management:-

The means by which the dental health team effectively and efficiently performs treatment for a child and simultaneouslyinstills a positive dental attitude in the child.To understand the pattern of child development various theories have been put forward.

Classification of Theories of Development:-

The theories are broadly classified as:-

Psychodynamic Theories

(b) Behavior Learning TheoriesPsychodynamic theories :-

Classical Psychoanalytical theory by Sigmund Freud (1905)

Psychosocial Developmental task theory by Erik Erikson(1963)

Hierarchy of needs by Abraham Maslow(1954)

Behavior learning theories :-

Classical conditioning theory by Ivan Pavlov.(1927)

Operant conditioning theory by

B.F Skinner.(1938)

Social learning theory by

Albert Bandura.(1963)

Theory of cognitive Development by Jean Piaget.(1952)

Psychodynamic theories:-

Classical Psychoanalytical theory:-

The first formal theory of personality to have marked impact on psychology and psychiatry was that of Sigmund Freud given in the year 1905. This concept of personality was based on the interaction between three systems within each individual. He called these systems as the Id, the Ego and the Super Ego.

The Id:-It is the source of all gratification and pleasure. It represents the unconscious, instinctive urges that motivate behavior. The id operates on what Freud described as the pleasure principle. But the inner urges of the id can find satisfaction only in external sources.

Hence Id can be defined as, the inherited reservoir of unorganized drives.It mostly unconscious, is governed by the pleasure-pain principle, aims at immediate satisfaction of libidinal urges, is immoral, is illogical, and lacks unity of purpose.

The Ego:-

It is the ego that makes the necessary interaction with the social world possible and permits the needs of the id to be satisfied. Although the ego serves as a way of satisfying id impulses, it responds to the reality principle. If the id were left entirely to its own devices, the organism would probably be destroyed. Thus the ego serves to control the Ids pleasure seeking.

Hence, the ego can be defined as the integrating or mediating part of personality, which develops out of interaction of Id and environment. It has perception both of the internal and of the external world.

The Superego:-

It acts as a conscience it is the internal part of the individual that makes the value judgments.

The superego is idealistic; it is not necessarily composed of societys standard unless the individual has accepted and internalized them.

The child is born without a superego.

This element of personality structure is developed under the training and influence of the environment.

It can be defined as the latest development of the mind embodying the code of the society and including

concepts of right and wrong, the value system and the ideals.

Freud postulated several major stages of development, each involving special adjustment problems and each contributing to childs behavior.

Oral Stage(Birth-18 months):- This stage is characterized by the infants concern for his mouth and the gratification he feels from oral stimuli.

Eating is the most obvious activity from which the child derives the maximum pleasure .

Oral stimulation is also produced by engaging in activities such as sucking, biting, swallowing and manipulating various parts of the mouth.

Freud contended that these activities are the childs means of fulfilling his sexual urges.

During this age the childs personality is controlled by the id. He demands immediate gratification of his desires. Oral Stage

(II) Anal stage(18 months -3 years)

In this stage the bowel movements becomes the source of the pleasure to the child.

He may defecate often to achieve this pleasure.

This however, would bring him in conflict with his parents. The conflict leads the child to develop an ego.

He comes to realize that he cannot always do what he wants, when he wants.

He learns that there are certain times when it is appropriate to expel waste and other time it is inappropriate.

He gradually comes to understand his mother wishes and abides by them.

(III) Phallic Stage(3-7 years):-

In this stage the childs central interest shifts to the genital region.

Sexual gratification becomes more erotic during this time

Each stage has certain difficult tasks associated with it where problems are more likely to arise. For the phallic stage they are:-

Oedipal complex:-

The first object of love for all of us is our mother.

The young boy however has a rival for his mothers love; his father.

He also recognizes the difference between boys and girls that he has a penis and girls do not.

(ii) Electra complex:-The girl child develops affection towards her father and sees the mother as her main rival. The girl child also recognizes difference between boy and girl and therefore suffers from penis envy. This is called Electra complex.

(IV) Latent stage(7-11 years):-

Freud believed that sexual impulses are suppressed in the service of learning. This is a relatively dormant stage from the view of psychological development.

(V)Genital stage(11-18 years):-

It is the longest of the five stages.

This period is similar to the anal stage. This is a renewed interest and pleasure derived from excretory activity.

This represents the resurgence of sex drive in adolescence and the more specific focusing of pleasure in sexual intercourse.

In the beginning, the person seeks association with the members of his own sex but associations are stronger in genital phase.

As the period progresses, the child makes contact and forms relationship with members of the opposite sex.

Also, at this time the superego undergoes further development and becomes more flexible.

Shortcomings of Freuds theory:-Too much emphasis has been placed on the role of the sexuality in psychological development.

Role of society in development of behavior has been totally neglected.

Psychosocial theory:-

Erik Erikson, a friend and student of Freud, elaborated and modified Freuds theory in 1963 by superimposition of psychosocial and psychosocial factors.

Eriksons theory postulates that the society responds to the childs basic needs or developmental tasks in each specific period of life.

His approach emphasizes the dependent interaction of the individual and the society.

Eriksons eight stages of development:-womb.

At each stages of development a child faces various developmental tasks and contradictory themes.If the child resolves the conflict successfully it results in positive outcome, if not it results in negative outcome.Trust vs. Mistrust(0-1 years):-Description:-The infant is helpless and seeks the same comfort and security as that of mothers womb. Infants depend on others to meet their basic needs, and therefore blindly trust the caregivers to provide them.

Positive outcome :- If their needs are met consistently and responsively, infants will learn to trust their environment and the people in it.Negative outcome:-If their needs are not responsively met, infants may view the world with mistrust.(ii) Autonomy vs. shame:-Description:Toddlers learn to explore and do things for themselves. Their self control and self-confidence begin to develop at this stage.

Positive outcome:-If the child is encouraged to explore and reassured when mistakes are made, the child will develop a sense of autonomy and confidence needed to cope with future situations.Negative outcome:-If parents are overprotective or extremely critical, the child may be ashamed of his behavior and doubt his/her abilities.

(iii) Initiative vs. guilt (2-6years) Description:-Children begin to interact with the environment, the motor and language skills begin to develop. They display an eagerness for adventure and play and learn to control impulsive behavior.POSITIVE OUTCOME:-If parents are encouraging and at the same time consistent in disciplining the child, he/she will learn to accept the concept of right and wrong and not feel ashamed in using his imagination.Negative outcome:-If the childs initiatives are constantly curtailed by the caregiver, he may develop a sense of guilt and may come to believe that it is wrong to be independent.

(iv) Industry vs. inferiority(6-12 years)Description:-School is the important event at this stage. Child learns to master basic social and academic skills. Peers become the key social agent at this stage.Positive outcome:-If the children can find pleasure in learning, being productive, and seeking success, they will develop a sense of industry and competenceNegative outcome:-If a child is unable to do so, he/she will develop feelings of inferiority that will be exhibited later in life as an inability to take up responsibility.

(v) Self identity vs. Role confusion:-Description:-This is the crossroad between childhood and maturity when adolescents begin to ask Who am I? The key social agent is the persons society of peers.Positive outcome:-Adolescents who solve this conflict successfully will develop a strong identity and will be ready to plan the future.Negative outcome:-If not the adolescent will sink into confusion and will be unable to make decisions and choices about his/her role in life.

The next three stages in Eriksons developmental theory are concerned with the development in adulthood. This period starts at about eighteen to twenty and extends into old age.According to Erikson, (i) An individual who is around 20 years of age begins to be concerned with the theme of intimacy which generally results in marriage or long lasting sexual union.(ii)In next stage the individual become concerned with being generative to improve themselves and the society in which they live.iii)Finally the last stage is concerned with the concept of ego integrity versus despair. If one successfully resolves all the crises or conflicts in life, then that individual looks back and develops a sense of ego and satisfaction. . On the other hand, if resolutions were unsuccessful in one or more stages of development, then a feeling of despair or incompetence arises in ones ego.

Behaviour Learning Theories:-

Classical conditioning theory:-

This theory was given by Ivan Pavlov in 1927.

According to this theory a child learns to associate two events that occur simultaneously and develops conditioned response eg. A child associates dental hand piece with pain and hence the mere sight or sound of handpiece can evoke anxiety

Classical conditioning Pavlovs famous experiment with a dog.

The principles involved in this process:-Acquisition:- learning a new response from the environment by conditioning.Generalization:- wherein the process of conditioning is evoked a band of stimuli centered around a specific conditioned stimulus. Thus a test stimulus similar to training stimulus results in a response. e.g. a child who has had a painful experience with the doctor in white coat will always associates any doctor in white coat with the pain.Extinction:- of the conditioned behavior results if the association between the conditioned and the unconditioned

response is not reinforced, e.g. in the above mentioned example subsequent visits to the doctor without any unpleasant experiences results in extinction of the fear.Discrimination:- is opposite of generalization. If the 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.

Operant conditioning theory:-This theory was put forward by B.F. Skinner in 1938. According to this theory the consequence of behavior itself acts as a stimulus and affects future behavior. Behavior that operates or control the environment is called operant.It stresses that reinforcement is the critical factor for learning and therefore for development of personality.Skinner described four basic types of operant conditioning by the type of consequences:-

Positive reinforcement:-It occurs if a pleasant consequence follows the response e.g a child rewarded for good behavior following dental treatment.Negative reinforcement:- It involves removal of unpleasant stimuli following a response e.g if the parent gives into the tamper tantrums thrown by a child, he reinforces this behavior.

Omission:-Refers to removal of the pleasant response after a particular response e.g if the child misbehaves during the dental procedure, his favorite toy is taken away for a short time resulting in the omission of the undesirable behavior.Punishment:-It involves introduction of an aversive stimulus into a situation to decrease the undesirable behavior. Eg: use of palatal rake in correction of tongue thrusting habits.

Social Learning theory:-

This theory was proposed by

Albert Bandura in 1963. According to this theory behavior is motivated by & social needs. An important concept of this theory is modeling which is imitation through observational learning.

Reinforcements are considered as adjuncts and not a necessity for behavior learning.

Cognitive theory:-

Jean Piaget, the worlds leading theorist in the field of cognitive development of children put forth the cognitive theory in 1952.According to Piaget, the environment does not shape child behavior, but the child and adult actively seek to understand the environment.

Assimilation: - concerns with observing, recognizing, taking up an object and relating it with earlier experiences or categories.

Accommodation:- Accounts for changing concepts and strategies as a result for new assimilated information.Piaget called the strategies and mental categories as schemas.Equilibration:-It refers to changing basic assumptions following adjustments in assimilated knowledge so that the fact fits better.Although Piaget does not place much emphasis on the influence of the psychosocial and psychosexual factors, he does hold that child development proceeds from an egocentric position through a predictable manner, step-wise consistent expansion and incorporation of learned experiences.

Piaget has delineated four major periods of cognitive growth, each characterized by distinct type of thinking.Sensorimotor stage.Preoperational stage.Concrete operational stage.Formal operational stage.

Sensorimotor Stage (birth-18 months):-

It is the first stage of the four stages of Piagets theory.

He designated the first eighteen months of the infants life as sensorimotor stage.

During this period, the infants are busy discovering relationships between their bodies and the environment.

The child relies on seeing, touching, sucking, feeling, and using their senses to learn things about themselves and their environment.

B) The Preoperational Stage(18months- 7 years)This stage occurs from eighteen months to seven years of age.It is divided into two periods.1) Pre-conceptual period(18months-4 years)2) Intuitive period(4- 7 years)Throughout most of the pre-operational stage a childs thinking is self centered, or egocentric.According to piaget during the pre- operational stage a child has difficulty in understanding life from any perspective other than his own.In this stage, the child is very me, myself, and I oriented.

(C) Concrete operatinal stage (7-12 years)This is the third stage in the Piagets theory.During this stage, a child begins to reason logically and organizes thoughts coherently however he can only think about actual physical objects, he cannot handle abstract reasoning.This stage is also characterized by loss of egocentric thinking, the childs ability to coordinate two dimensions of an object simultaneously, arrange structures in sequence and transpose differences between items in a series. D) The Formal Operational Stage(12-13 years):-It is the fourth and the final stage in Piagets theory.It begins at 12-13 years of age and continues throughout the adulthood.It is characterized by the ability to formulate hypothesis and systematically test them to arrive at an answer to a problem.

Application Of Piagets Theory:-Constructivism:-Piaget theorized that a child acquisition of reality is accomplished by touching, exploring and observing.The child in dental sitting constructs his/her knowledge about the unknown world of dentistry through activities such as handling and working with dental instruments, observing and touching appliances and smelling various materials.

2) Cognitive Equilibrium:-According to Piagets theory knowledge acquired by a child produces a state of balance called cognitive equilibrium.The passage through each developmental stage is characterized by acquisition of new, more permanent knowledge about the dental instruments and techniques. This can be utilized by the dentist by encouraging the child to acquire knowledge about the dental instruments and techniques.

The dentist must use the curiosity of the child to gain knowledge in developing a positive dental attitude.3) Animism:-Using Piagets principle, dental instruments and materials may be given life like names e.g. a handpiece could be referred to as whistling barney. The principle of physiognomic properties is a state where in child perceives that inanimate objects take on the form and emotions of human beings.This phenomenon can be effectively used because fantasy play and language

when used repeatedly help the child to become more comfortable.4) Centering:-Piaget believed that a child focuses on the most important characteristics of what he or she sees, excluding everything else.During the treatment the child can be given a mouth mirror to look in. the child should be directed to focus attention in the mirror , watch the treatment and concentrate on what is happening.

5) Egocentrism:-Piaget believed that children view the world in self centric manner. A child believes that his or her point is the only right one.This can be put to practical use in the dental clinic by making the child feel more important.

Hierarchy of Needs:-This theory was proposed by Abraham Maslow in 1954.Maslow believed in the self- actualization theory i.e. the need to understand the totality of a person. He gave the forward following thoughts:

The needs are arranged in a hierarchy and as one general type of need is satisfied, another higher order need will emerge. The desires from most biologic needs to the more physiological ones become important only after basic needs have been satisfied.Motivation is constantly required and is a never ending, fluctuating complex present in almost all organisms.Pain avoidance, tension reduction, and pleasure act as sources of motivating behavior.

Merit of hierarchy of needs:-

Based on the total personality development.

Demerit of Hierarchy of Needs:-

This theory is difficult and impractical to apply in children in dental situations as the child has an ever changing personality.

Conclusion:-

These theories help in understanding how developmental changes occur in the behavior and understanding of the child. A thorough knowledge of these theories helps in effective behavior management of a child in the dental operatory.