Child psychology

CHILD PSYCHOLOGY
Presented by
Dr.sinu jayaprakash
Dept of pedodontics
Kmct dental college

CONTENTS
• Introduction
• History
• Theories of child psychology
Psychodynamic theories
• Psychosexual /Psychoanalytic theory by Sigmund
Freud
• Psychosocial / Model of personality development
by Erick Erikson
• Cognitive theory by Jean Piaget

Introduction
• The word psychology literally means, "study of the
soul”
• Child psychology focuses on the mind and behaviour
of children from prenatal development through
adolescence.It deals not only with how children grow
physically, but with their mental, emotional and social
development as well.
The Different Contexts of Child Psychology
• Development involves much more than the
influences that arise from within an individual.

Environmental factors such as social relationships
and the culture in which we live also play essential
roles.Some of the major contexts that we need to
consider in our analysis of child psychology include:
• The Social Context: Relationships with peers and
adults have an effect on how children think, learn and
develop. Families, schools and peer groups all make
up an important part of the social context.

• The Cultural Context: The culture a child lives in
contributes a set of values, customs, shared
assumptions and ways of living that influence
development throughout the lifespan. Culture may play
a role in how children relate to their parents, the type of
education they receive and the type of child care that is
provided.
• The Socioeconomic Context: Social class can also play
a major role in child development. Socioeconomic
status (often abbreviated as SES), is based upon a
number of different factors including how much
education people have, money they earn, the job they
hold and where they live.

• Children raised in households with a high SES tend to
have greater access to opportunities, while those from
households with lower SES may have less access to
health care, quality nutrition and education. Such
factors can have a major impact on child psychology.
• All these contexts are constantly interacting. While a
child may have fewer opportunities due to a low
socioeconomic status, enriching social relationships
and strong cultural ties may help correct this
imbalance.

History
• John Locke and Jean-Jacques Rousseau are typically
cited as providing the foundations of modern form of
developmental psychology. In the mid-18th century
Jean Jacques Rousseau described 3 stages of
childhood: infans (infancy), puer (childhood) and
adolescence in Emile: Or, On Education.
• In the late 19th century, psychologists familiar with
the evolutionary theory of Darwin began seeking an
evolutionary description of psychological
development.

Psychologist G. Stanley Hall attempted to correlate
ages of childhood with previous ages of mankind.
James Mark Baldwin wrote essays on topics that
included Imitation: A Chapter in the Natural History
of Consciousness and Mental Development in the
Child and the Race: Methods and Processes. Baldwin
was heavily involved in the theory of developmental
psychology. Sigmund Freud, whose concepts were
developmental, had a significant impact on public
perceptions.

Theories of child psychology
Broadly classified into 2 groups
Psychodynamic theories
• Psychosexual /Psychoanalytic theory by Sigmund
Freud (1905)
• Psychosocial / Model of personality development
by Erick Erikson (1963)
• Cognitive theory by Jean Piaget (1952)

Theories of learning and development of behavior
• hierarchy of needs by Maslow (1954)
• social learning theory by Bandura (1963)
• classical conditioning by Pavlov (1927)
• operant conditioning by Skinner (1938)

• The psychodynamic approach includes all the
theories in psychology that see human functioning
based upon the interaction of drives and forces within
the person, particularly unconscious, and between the
different structures of the personality.

Psychoanalytical Theory
• Given by Sigmund Freud.
• It describes how personality develops during childhood.
While the theory is well-known in psychology, it is also
one of the most controversial theories. It suggested that
personality is mostly established by the age of 5. Early
experiences play a large role in personality development
and continue to influence behavior later in life.
• This theory is based on the belief that developmental
changes occur because of the influence of internal drives
and emotions on behavior.

• Described human mind with the help of 2 models.
• Topographic model
• Psychic model/ psychic triad
Topographic model
• According to this model human mind consist of
conscious, preconscious and subconscious mind.

• Conscious mind is where we are paying attention at
the moment.
• It includes only our current thinking processes and
objects of attention and constitutes a large part of our
current awareness.
• Preconscious mind involves ordinary memory and
knowledge, things of which we aware, but we are not
paying attention at all moments but can deliberately
bring them into conscious mind by focusing.

• Unconscious/ subconscious mind is where the process
and content are out of direct reach of conscious mind.
It consists of that part of mind which thinks and acts
independently, acts as a dump box for urges, feelings
and ideas and exerts influence on our actions and our
conscious awareness.
• Freud described human mind is like an iceberg. Only
10% of iceberg is visible (conscious), whereas 90% is
beneath (unconscious).

Psychic model/ psychic triad
• The human psyche(personality) structured into 3 parts
(i.e. tripartite), the id, ego and superego, all
developing at different stages in our lives.
• Id: basic structure of personality, which serves as a
reservoir of instincts or their mental representative. It
is present at birth, impulse ridden and strives for
immediate pleasure and gratification (pleasure
principle). Eg: need to eat in a young child is based
on pleasure principle. i.e, child wants food
irrespective of external circumstances.

• id means "it."
• Freud described the id as "chaos, a cauldron full of
seething excitation" dominated by impulses of sex
and aggression. Freud proposed that the id was the
source of the libido, a source of energy for the entire
psyche. This energy was expressed in drives or urges
like sex and aggression. (Freud used the German
word trieb, which means a motivating tendency,
sometimes translated as "wish.")

• The pleasure principle might be described as "I want
what I want when I want it." Primary process
thinking, which Freud believed was typical of
unconscious mental processes, was said to be
dominated by the pleasure principle. It aimed to
satisfy the demands of the id in irrational, unrealistic
ways, often through fantasy. Freud believed, for eg,
that dreams were aimed at satisfying id impulses.
• He believed babies were "all id" when born.

• Unconsciously, he believed, we are all like little
children: we want immediate gratification and have
low tolerance for frustration. Only the development
of more mature, controlling parts of the mind helps us
avoid expressing id impulses and acting like babies
when we are grown up.
• It consists of all the inherited (i.e. biological)
components of personality, including the sex (life)
instinct – Eros (which contains the libido), and
aggressive (death) instinct - Thanatos.

• Ego: develops out of id in 2nd to 6th month of life
when the infant begins to distinguish between itself
and outside world. It is “that part of the id which has
been modified by the direct influence of the external
world”
• It is the mediation between id and super ego.
• It is concerned with memory and judgement.
• It is developed after birth, expands with age and it
delays, modifies and controls id impulses on a
realistic level(reality principle).

• Ego means "I."
• Modern theorists sometimes refer to the ego as the
executive function.
• The part of the mind/body system that Freud called
the ego is the part that executes plans and coordinates
activity.
• Ego is the drawing power from the id while
controlling it, as resembling a rider on a horse.

• In this metaphor the horse represents the id: a
primitive, animal-like source of energy. The rider
represents the ego. It may be weak or strong, clumsy
or skillful. If the rider is uncoordinated or lacking in
skill, the horse goes whatever direction it pleases, and
the rider must hold on for their life. This is like a
person whose impulses are out of control, poorly
coordinated by the ego. If the rider is an expert, the
horse becomes like an extension of the rider's
willpower, making the rider swifter and more
powerful than a human on foot.

• Similarly, in Freud's view, the id provided raw energy,
and the ego (if skillful or well controlled) used this
energy to do remarkable, positive things.
• In Freud's scheme the ego is not entirely conscious.
Some of the plans and activities a person coordinates
may not be conscious.

• For eg, repression of unpleasant memories is an
activity that Freud attributed to the ego, and it was
thought to be an unconscious sort of defense.
Similarly, the other defense mechanisms were said to
be unconscious functions of the ego, carried out to
defend the psyche (the overall mental system) against
painful thoughts and emotions.

• Freud said the ego develops in early childhood. Little
children discover that id-impulses often cannot be
gratified immediately. The pleasure principle is not
realistic. Sometimes, to get what you want, you must
be rational or tolerate a delay. The ego develops as a
result of this clash between desires of the id and
realities of the world. With the development of the
ego comes, conscious rational thinking. Freud called
this secondary process thinking because it occurs later
in development and modifies the most animal-like
primary process thinking.

• While primary process thinking is dominated by the
pleasure principle, secondary process thinking-that
which is controlled by the ego-is based on the reality
principle. Freud described the reality principle as the
ability of the ego to make plans that take reality into
account, even if it means postponing pleasure or
enduring pain.

• Ego is concerned with a state in which adequate
expression of id can occur within the constraints of
reality and demands and restriction of superego. Eg:
hunger must wait until food is given.
• Freud believed that there is a constant unconscious
drive in humans to seek pleasure, which he called the
libido .

Super ego: (above I) it is the prohibition learned from
environment(more from parents and authorities).
• It acts as a censor of acceptability of thoughts,
feelings and behavior.
• It is determined by regulations imposed upon child by
parents, society and culture (ethics and morals).
• Freud believed that we learn morals and values from
the people who take care of us in childhood
• It develops around the age of 3 – 5 years during the
phallic stage of psychosexual development.

• Gradually these values are internalized or taken inside
us, and the result is the super-ego. He said the super-
ego, as an "internalization of parental values," was
responsible for both pride and guilt.
• Because of this two-edged quality, one psychoanalyst
(Schecter 1979) referred to the loving and
persecuting super-ego.
• According to Freud, the super-ego was partly
unconscious.

• The superego's function is to control the id's impulses,
especially those which society forbids, such as sex and
aggression. It also has the function of persuading the
ego to turn to moralistic goals rather than simply
realistic ones and to strive for perfection.
• The superego consists of two systems: The conscience
and the ideal self. The conscience can punish the ego
through causing feelings of guilt. For example, if the
ego gives in to the id's demands, the superego may
make the person feel bad through guilt.

• The ideal self (or ego-ideal) is an imaginary picture
of how you ought to be, and represents career
aspirations, how to treat other people, and how to
behave as a member of society.
• Behavior which falls short of the ideal self may be
punished by the superego through guilt. The super-
ego can also reward us through the ideal self when we
behave ‘properly’ by making us feel proud.

• If a person’s ideal self is too high a standard, then
whatever the person does will represent failure. The
ideal self and conscience are largely determined in
childhood from parental values and how you were
brought up.
• Freud, S. (1920). Beyond the pleasure principle. SE,
18: 1-64.
• Freud, S. (1923). The ego and the id. SE, 19: 1-66.

• The word psyche refers to the mind as a whole. Freud
believed much of the psyche was unconscious; he
compared it to an iceberg, which was 9/10th under
water. In his theory, Freud distinguished between the
id (the primitive, animal-like part of the mind,
supposedly the source of energy for the psyche), the
ego (the "agent of adaptation" in the psyche, mostly
conscious) and the super-ego (the source of self-
evaluation, guilt and pride, an internalization of
parental values).

The id was totally unconscious, the super-ego was
partly unconscious, and the ego was mostly accessible
to consciousness

• Freud said the ego is often caught in a struggle
between the id and super-ego, which pull in opposite
directions
• Ego's function: to serve as the master executive,
juggling all the priorities, planning out the best course
of action.
• Dewey, R.A. (2007) “Freud’s Theory.” Psychology:
An Introduction. Ch 11, Pt. II.

Ego defenses
• Memories banished to the unconscious or unacceptable
drives or urges do not disappear. They continue to exert a
powerful influence on behaviour. The forces, which try to
keep painful or socially undesirable thoughts and
memories out of the conscious mind, are termed defense
mechanisms.
• Without defense mechanisms, Freud believed that the
person with conflicting personality components would be
under so much stress that they develop mental illness or
kill themselves.

Repression
• This was the first defense mechanism that Freud
discovered.
• This is not a very successful defence in the long term
since it involves forcing disturbing wishes, ideas or
memories into the unconscious, where, although
hidden, they will create anxiety.

Displacement
• Displacement is the redirection of an impulse (usually
aggression) onto a powerless substitute target. The
target can be a person or an object that can serve as a
symbolic substitute.

Sublimation
• This is similar to displacement, but takes place when
we manage to displace our emotions into a
constructive rather than destructive activity. This
might for example be artistic. Many great artists and
musicians have had unhappy lives and have used the
medium of art of music to express themselves.

Rationalization
• Rationalization is the cognitive distortion of "the
facts" to make an event or an impulse less
threatening. Eg: after poor performance in exam,
student may try to rationalize the same by blaming
the teacher of doing strict marking.

Reaction Formation
• This is where a person goes beyond denial and
behaves in the opposite way to which he or she thinks
or feels. Conscious feelings are the opposite of the
unconscious. Love - hate. Shame - disgust and
moralizing are reaction formation against sexuality.
When you had a bad experience of dental treatment to
prevent anxiety you start thinking about the positive
things about the Rx.

• Freud, A. (1937). The Ego and the Mechanisms of
Defense, London: Hogarth Press and Institute of
Psycho-Analysis.
• Freud, S. (1894). The neuro-psychoses of defence.
SE, 3: 41-61.
• Freud, S. (1896). Further remarks on the neuro-
psychoses of defence. SE, 3: 157-185.
• Freud proposed that psychological development in
childhood takes place in a series of fixed stages.

These are called psychosexual stages because each
stage represents the fixation of libido (roughly
translated as sexual drives or instincts) on a different
area of the body. As a person grows physically certain
areas of their body becomes important as sources of
potential frustration (erogenous zones), pleasure or
both.
Freud believed that life was built around tension and
pleasure. Freud also believed that all tension was due
to the build up of libido (sexual energy) and that all
pleasure came from its discharge.

The Role of Conflict
• Each of the psychosexual stages is associated with a
particular conflict that must be resolved before the
individual can successfully advance to the next stage.
The resolution of each of these conflicts requires the
expenditure of sexual energy and the more energy
that is expended at a particular stage the more the
important characteristics of that stage remain with the
individual as he matures psychologically.

• To explain this Freud suggested the analogy of
military troops on the march. As the troops advance
they are met by opposition or conflict. If they are
highly successful in winning the battle (resolving the
conflict) then most of the troops (libido) will be able
to move on to the" next battle (stage).
• But the greater the difficulty encountered of any
particular point the greater the need for troops to
remain behind to fight and thus the fewer that will be
able to go on to the next confrontation.

Frustration, Overindulgence and Fixation
• Some people do not seem to be able to leave one
stage and proceed on to the next. One reason for this
may be that the needs of the developing individual at
any particular stage may not have been adequately
met in which case there is frustration. Or possibly the
person's needs may have been so well satisfied that he
is reluctant to leave the psychological benefits of a
particular stage in which there is overindulgence.

• Both frustration and overindulgence (or any
combination of both) may lead to fixation at a
particular psychosexual stage.
• Fixation refers to the theoretical notion that a portion
of the individual's libido has been permanently
'invested in a particular stage of his development. It is
assumed that some libido is permanently invested in
each psychosexual stage and thus each person will
behave in some ways that are characteristic of
infancy, or early childhood.

Freud described 5 psychosexual stages.At each stage
sexual energy is invested in a particular part called an
erogenous zone.

Oral Stage (0-1 year)
• The 1st stage of personality development where libido
is centred in a baby's mouth. It gets much satisfaction
from putting all sorts of things in its mouth to satisfy
libido, and thus its id demands. This stage in life are
oral, or mouth orientated, such as sucking, biting, and
breast-feeding.
• Freud said oral stimulation could lead to an oral
fixation in later life. Oral personalities around us
include smokers, nail-biters, finger-chewers, and thumb
suckers. Oral personalities engage in such oral
behaviors particularly when under stress.

Anal Stage (1-3 years)
• The libido now becomes focused on the anus and
the child derives great pleasure from
defecating. The child is now fully aware that they
are a person in their own right and that their
wishes can bring them into conflict with the
demands of the outside world (i.e. their ego has
developed).
• Freud believed that this type of conflict tends to
come to a head in potty training, in which adults
impose restrictions on when and where the child
can defecate.

• The nature of this 1st conflict with authority can
determine the child's future relationship with all
forms of authority.
• Early or harsh potty training can lead to the child
becoming an anal-retentive personality who hates
mess, is obsessively tidy, punctual and respectful of
authority. They can be stubborn and tight-fisted with
their cash and possessions.

Phallic Stage (3 to 5 or 6 years)
• Sensitivity now becomes concentrated in the genitals
and masturbation (in both sexes) becomes a new
source of pleasure. The child becomes aware of
anatomical sex differences. The primary conflict at
this stage is a desire to possess the opposite-sex
parent. Completion of this stage results in identifying
with the same-sex parent.

Oedipus Complex
• The most important aspect of the phallic stage. This is
one of Freud's most controversial ideas and one that
many people reject outright.
• The name derives from Greek myth where Oedipus, a
young man, kills his father and marries his mother.
Upon discovering this he pokes his eyes out and
becomes blind.

• In the young boy, the Oedipus complex or more
correctly conflict, arises because the boy develops
sexual (pleasurable) desires for his mother. He wants
to possess his mother exclusively and get rid of his
father to enable him to do so. However the child fears
that he will be punished by the father for these
feelings, a fear Freud termed castration anxiety. In
the phallic stage what the boy loves most is his penis.
Hence the boy develops castration anxiety.

• A problem the little boy then sets out to resolve by
imitating, copying and joining in masculine dad-type
behaviors. This is called identification, and is how
the 3-5 year old boy resolves his Oedipus complex.
Identification means internally adopting the values,
attitudes and behaviors of another person. The
consequence of this is that the boy takes on the male
gender role, and adopts an ego ideal and values that
become the superego.

Electra Complex
• The girl desires the father, but realizes that she does
not have a penis. This leads to the development of
penis envy and the wish to be a boy.
• The girl resolves this by repressing her desire for her
father and substituting the wish for a penis with the
wish for a baby. The girl blames her mother for her
'castrated state' and this creates great tension.

Latency Stage (5 or 6 to puberty)
• No further psychosexual development takes place
during this stage (latent means hidden). The libido is
dormant. Freud thought that most sexual impulses are
repressed during the latent stage and sexual energy
can be sublimated towards school work, hobbies and
friendships. Much of the child's energies are
channelled into developing new skills and acquiring
new knowledge and play becomes largely confined to
other children of the same gender.

Genital Stage (puberty to adult)
• Is the last stage of Freud's psychosexual theory and
begins in puberty. It is a time of adolescent sexual
experimentation, the successful resolution of which is
settling down in a loving one-to-one relationship with
another in our 20's or so. Sexual instinct is directed
to heterosexual pleasure, rather than self pleasure
during the phallic stage.

• For Freud, the proper outlet of the sexual instinct in
adults was through heterosexual intercourse. Fixation
and conflict may prevent this with the consequence
that sexual perversions may develop.

Merits
• One of the earliest and most comprehensive theories
of life long psychological development.
Demerits
• Freud formulated this theory by his extensive studies
on adult psychological patients and hence its
extrapolation to children is not justified.
• This theory is based on obsessed observations of
psychologist.

Neo-Freudianism
• The Neo-Freudian psychologists were a group of loosely
linked American theorists of the mid-twentieth century, who
were all influenced by Sigmund Freud, but who extended
his theories, often in social or cultural directions. They have
been defined as 'American writers who attempted to restate
Freudian theory in sociological terms and to eliminate its
connections with biology'. First, the Neo-Freudian was born
in Germany (Neopsychoanalyse) (1945) by the German
psychiatrist Harald Schultz-Hencke. Erikson for his part
stressed that 'psychoanalysis today is shifting its emphasis
to the study of the ego's roots in social organisation‘.
• Charles Rycroft, A Critical Dictionary of Psychoanalysis
(London 1995) p. 60

Development of post-Freudian theory
• Erikson was a student of Anna Freud, the daughter of
Freud, whose psychoanalytic theory and
psychosexual stages contributed to the basic outline
of the 8 stages, at least those concerned with
childhood. The 1st 4 of Erikson's life stages
correspond to Freud's oral, anal, phallic, and latency
phases, respectively. Also, the 5th stage of
adolescence is said to parallel the genital stage in
psychosexual development:

• Although the first 3 phases are linked to those of the
Freudian theory, it can be seen that they are
conceived along very different lines.
• Emphasis is not so much on sexual modes and their
consequences as on the ego qualities which emerge
from each stages. There is an attempt also to link the
sequence of individual development to the broader
context of society.
• Erikson saw a dynamic at work throughout life, one
that did not stop at adolescence.

• He also viewed the life stages as a cycle: the end of
one generation was the beginning of the next. Seen in
its social context, the life stages were linear for an
individual but circular for societal development:
• In Freud's view, development is largely complete by
adolescence. In contrast, one of Freud's students,
Erikson believed that development continues
throughout life. Erikson took the foundation laid by
Freud and extended it through adulthood and into late
life.

CHILD PSYCHOLOGY
Presented by
Dr. Aswathi Joseph
IInd year PG
Dept of Pedodontics

Psychosocial theory by Erik Erikson
Theory of developmental tasks
• One of the best-known theories of personality in
psychology. Much like Freud, Erikson believed that
personality develops in a series of stages. Unlike
Freud’s theory of psychosexual stages, Erikson’s theory
describes the impact of social experience across the
whole lifespan.
• One of the main elements of Erikson’s theory is the
development of ego identity. Ego identity is the
conscious sense of self that we develop through social
interaction.

• According to Erikson, our ego identity is constantly
changing due to new experience and information we
acquire in our daily interactions with others. He
believed that a sense of competence also motivates
behaviors and actions. Each stage in Erikson’s theory
is concerned with becoming competent in an area of
life.
• If the stage is handled well, the person will feel a
sense of mastery, which he referred to as ego strength
or ego quality.

• If the stage is managed poorly, the person will emerge
with a sense of inadequacy. In each stage, Erikson
believed people experience a conflict that serves as a
turning point in development. In his view, these
conflicts are centered on either developing a
psychological quality or failing to develop that
quality.
• During these times, the potential for personal growth
is high, but so is the potential for failure.

The Epigenetic Psychosexual Stages
• Erikson believed that childhood is very important in
personality development. He accepted many of Freud's
theories, including the id, ego, and superego, and Freud's
theory of infantile sexuality. But he rejected Freud's attempt
to describe personality solely on the basis of sexuality, and,
felt that personality continued to develop beyond 5 years of
age.
• All of the stages in Erikson's epigenetic theory are
implicitly present at birth (at least in latent form), but unfold
according to both an innate scheme and one's up-bringing in
a family that expresses the values of a culture. Each stage
builds on the preceding stages, and paves the way for
subsequent stages.

• Each stage is characterized by a psychosocial crisis,
which is based on physiological development, and on
demands put on the individual by parents and/or
society. Ideally, the crisis in each stage should be
resolved by the ego in that stage, in order for
development to proceed correctly. The outcome of one
stage is not permanent, but can be altered by later
experiences. Everyone has a mixture of the traits
attained at each stage, but personality development is
considered successful if the individual has more of the
"good" traits than the "bad" traits.

Ego Psychology
• Erikson's theory of ego psychology holds certain
tenets that differentiate his theory from Freud's. It
includes:
• The ego is of utmost importance.
• Part of the ego is able to operate independently of the
id and the superego.
• The ego is a powerful agent that can adapt to
situations, thereby promoting mental health.

• Social and sexual factors both play a role in
personality development.
• Erikson's theory was more comprehensive than
Freud's, and included information about "normal"
personality as well as neurotics. He also broadened
the scope of personality to incorporate society and
culture, not just sexuality.

• According to Erikson each individual passes through
8 developmental stages which is characterized by a
different psychological crisis which must be resolved
by the individual before he can move on to next stage.
If a resolution goes wrong it leads to maladaptations
& malignancies.
• Maladaptation: positive trait in excess & too little
of negative trait.Eg: a person who trusts too much
• Malignancies: too little of positive and too much of
negative.Eg: a person who cannot trust others

Hopes: Trust vs. Mistrust (Oral-sensory, Birth-2
years)
• Existential Question: Can I Trust the World?
• The 1st stage of Erikson's theory centers around the
infant's basic needs being met by the parents and this
interaction leading to trust or mistrust. Trust as defined
by Erikson is "an essential truthfulness of others as well
as a fundamental sense of one's own trustworthiness."
The infant depends on the parents, especially the
mother, for sustenance and comfort. The child's relative
understanding of world and society come from the
parents and their interaction with the child.

• If the parents expose the child to warmth, regularity,
and dependable affection, the infant's view of the
world will be one of trust. Should the parents fail to
provide a secure environment and to meet the child's
basic needs; a sense of mistrust will result.
Development of mistrust can lead to feelings of
frustration, suspicion, withdrawal, and a lack of
confidence. The basic fear of this stage is ‘fear of
abandonment’

• According to Erikson, the major developmental task in
infancy is to learn whether or not, other people
especially primary caregivers, regularly satisfy basic
needs. If caregivers are consistent sources of food,
comfort, and affection, an infant learns trust- that others
are dependable and reliable. If they are neglectful, or
perhaps even abusive, the infant instead learns mistrust-
that the world is in an undependable, unpredictable, and
possibly a dangerous place. While negative, having
some experience with mistrust allows the infant to gain
an understanding of what constitutes dangerous
situations later in life.

Dental applications
• This stage identifies with development of separation
anxiety in the child. So if necessary to provide dental
Rx at this early stage, it is preferably to do with the
parent present and preferably with parent holding the
child.
• Once the child looses basic trust with the world, it is
very difficult to gain confidence of the child and will
require special efforts to establish support with dentist
and staff.

Will: Autonomy vs. Shame & Doubt (Muscular-
Anal, 2-4 years)
• Existential Question: Is It OK to Be Me?
• As the child gains control over eliminative functions
and motor abilities, they begin to explore their
surroundings. The parents still provide a strong base of
a security from which the child can venture out to assert
their will. The parents' patience and encouragement
helps foster autonomy in the child. Children at this age
like to explore the world around them and they are
constantly learning about their environment.

• Caution must be taken at this age while children may
explore things that are dangerous to their health and
safety.
• The principle fear of this stage is ‘fear of loss of love’
and ‘fear of separation’

• At this age children develop their 1st interests. For
eg, a child who enjoys music may like to play with
the radio. Children who enjoy the outdoors may be
interested in animals and plants. Highly restrictive
parents, however, are more likely to instill in the child
a sense of doubt, and reluctance to attempt new
challenges.
• As they gain increased muscular coordination and
mobility, toddlers become capable of satisfying some
of their own needs.

• They begin to feed themselves, wash and dress
themselves, and use the bathroom.
• If caregivers encourage self-sufficient behavior,
toddlers develop a sense of autonomy—a sense of
being able to handle many problems on their own.
But if caregivers refuse to let children perform tasks
of which they are capable, or ridicule early attempts
at self-sufficiency, children may instead develop
shame and doubt about their ability to handle
problems.

Dental application
• Child is moving away from mother, still will retreat to
her in threatening situations. So parent’s presence is
essential in dental clinic. 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 Rx is his choice not of dentist/parent.

Purpose: Initiative vs. Guilt (Locomotor-Genital,
Preschool, 4-5 years)
• Existential Question: Is it OK for Me to Do, Move, and
Act?
• Initiative adds to autonomy the quality of undertaking,
planning and attacking a task for the sake of just being
active and on the move. The child is learning to master
the world around them, learning basic skills and
principles of physics. Things fall down, not up. Round
things roll. They learn how to zip and tie, count and
speak with ease. At this stage, the child wants to begin
and complete their own actions for a purpose.

• Guilt is a confusing new emotion. They may feel
guilty over things that logically should not cause
guilt. They may feel guilt when this initiative does
not produce desired results.
• The development of courage and independence are
what set preschoolers (3-6 years of age), apart from
other age groups. The primary fear of this stage is
‘Fear of bodily injury’

• The child during this stage faces the complexities of
planning and developing a sense of judgment. During
this stage, the child learns to take initiative and
prepare for leadership and goal achievement roles.
Activities sought out by a child in this stage may
include risk-taking behaviors, such as crossing a
street alone or riding a bike without a helmet; both
these egs involve self-limits.

• Within instances requiring initiative, the child may also
develop negative behaviors. These behaviors are a
result of the child developing a sense of frustration for
not being able to achieve a goal as planned and may
engage in behaviors that seem aggressive, ruthless, and
overly assertive to parents. Aggressive behaviors, such
as throwing objects, hitting, or yelling, are egs of
observable behaviors during this stage.
• Preschoolers are increasingly able to accomplish tasks
on their own, and can start new things. With this
growing independence comes, many choices about
activities to be pursued.

• Sometimes children take on projects they can readily
accomplish, but at other times they undertake projects
that are beyond their capabilities or that interfere with
other people's plans and activities. If parents and
preschool teachers encourage and support children's
efforts, while also helping them make realistic and
appropriate choices, children develop initiative-
independence in planning and undertaking activities.
But if, instead, adults discourage the pursuit of
independent activities or dismiss them as silly and
bothersome, children develop guilt about their needs
and desires.

Dental application
• Child can be encouraged to view this visit as a new
adventure and encouraged to genuine success in it. If
this visit fails, it can lead to sense of guilt in child. He
is inherently teachable at this stage and so can be
taught about various things in dental set up.
Independence has to be reinforced rather than
dependence.

Competence: Industry vs. Inferiority (Latency, 5-12
years)
• Existential Question: Can I Make it in the World of
People and Things?
• Children at this age are becoming more aware of
themselves as individuals. They work hard at "being
responsible, being good and doing it right." They are
now more reasonable to share and cooperate. Children
grasp the concepts of space and time in more logical,
practical ways. They gain a better understanding of
cause and effect, and of calendar time.

• At this stage, children are eager to learn and
accomplish more complex skills: reading, writing,
telling time. They also get to form moral values,
recognize cultural and individual differences and are
able to manage most of their personal needs and
grooming with minimal assistance. At this stage,
children might express their independence by talking
back and being disobedient and rebellious.

• The elementary school years are critical for the
development of self-confidence. It provides many
opportunities for children to achieve the recognition
of teachers, parents and peers by producing things-
drawing pictures, solving addition problems, writing
sentences, and so on.

• If children are encouraged to make and do things and
are then praised for their accomplishments, they
begin to demonstrate industry by being diligent,
persevering at tasks until completed, and putting
work before pleasure.
• If children are instead ridiculed or punished for their
efforts or if they find they are incapable of meeting
their teachers' and parents' expectations, they develop
feelings of inferiority about their capabilities.

• At this age, children start recognizing their special
talents and continue to discover interests as their
education improves. They may begin to choose to do
more activities to pursue that interest, such as joining
a sport if they know they have athletic ability, or
joining the band if they are good at music. If not
allowed to discover their own talents in their own
time, they will develop a sense of lack of motivation,
low self-esteem, and lethargy. They may become
"couch potatoes" if they are not allowed to develop
interests.

Dental application
• Child drive for sense of industry and
accomplishment, cooperation with Rx can be
obtained. This needs to be positively reinforced.
Cooperation at this stage depends on whether he/she
understands what is needed to please dentist/parents,
whether the desired behavior is reinforced by the
dentist. They like to get attention of the peer groups
Eg: improved appearance by dental treatment rather
than better chewing efficiency (for motivation)

Fidelity: Identity vs. Role Confusion
(Adolescence, 13-19 years)
• Existential Question: Who Am I and What Can I Be?
• The adolescent is newly concerned with how they
appear to others. The ability to settle on a school or
occupational identity is pleasant. In later stages of
adolescence, the child develops a sense of sexual
identity. As they make the transition from childhood
to adulthood, adolescents ponder the roles they will
play in the adult world.

• Initially, they are apt to experience some role
confusion—mixed ideas and feelings about the
specific ways in which they will fit into society and
may experiment with a variety of behaviors and
activities (e.g. baby-sitting for neighbors, affiliating
with certain political or religious groups). Eventually,
most adolescents achieve a sense of identity regarding
who they are and where their lives are headed.

• Erikson is credited with coining the term "Identity
Crisis." Each stage that came before and that follows
has its own 'crisis', but even more so now, for this
marks the transition from childhood to adulthood.
This passage is necessary because "Throughout
infancy and childhood, a person forms many
identifications. But the need for identity in youth is
not met by these." In relation to the 8 life stages as a
whole, the 5th stage corresponds to the crossroads.

• What is unique about the stage of Identity is that it is
a special sort of synthesis of earlier stages and a
special sort of anticipation of later ones. Youth has a
certain unique quality in a person's life; it is a bridge
between childhood and adulthood. Youth is a time of
radical change— body changes accompanying
puberty, the ability of the mind to search one's own
intentions and the intentions of others, the suddenly
sharpened awareness of the roles society has offered
for later life.

• Adolescents "are confronted by the need to re-
establish boundaries for themselves and to do this in
the face of an often potentially hostile world." This is
often challenging since commitments are being asked
for before particular identity roles have formed. At
this point, one is in a state of 'identity confusion', but
society normally makes allowances for youth to "find
themselves," and this state is called 'the moratorium':

• One of the problem of adolescence is role
confusion—a reluctance to commit which may haunt
a person into his mature years.
• As in other stages, bio-psycho-social forces are at
work. No matter how one has been raised, one’s
personal ideologies are now chosen for oneself.

• Often, this leads to conflict with adults over religious
and political orientations. Another area where
teenagers are deciding for themselves is their career
choice, and often parents want to have a decisive say
in that role. According to Erikson, when an
adolescent has balanced both perspectives of “What
have I got?” and “What am I going to do with it?” he
or she has established their identity.

• Dependent on this stage is the ego quality of fidelity—
the ability to sustain loyalties freely pledged in spite of
the inevitable contradictions and confusions of value
systems.
• Given that the next stage (Intimacy) is often
characterized by marriage, many are tempted to cap off
the 5th stage at 20 years of age. However, these age
ranges are actually quite fluid, especially for the
achievement of identity, since it may take many years
to become grounded, to identify the object of one's
fidelity, to feel that one has "come of age." Erikson
determined that their crises ended at ages 25 and 30,
respectively:

• The time of Identity crisis for persons of genius is
frequently prolonged. In our industrial society,
identity formation tends to be long, because it takes
us so long to gain the skills needed for adulthood’s
tasks in our technological world. So we do not have
an exact time span in which to find ourselves. A very
approximate rule of thumb for our society would put
the end somewhere in one's twenties.

Dental application
• Behavior management of adolescents can be
challenging. Any orthodontic Rx should be carried
out if child wants it and not parents as at this stage,
parental authority is being rejected. Approval of peer
group is extremely important.

Love: Intimacy vs. Isolation (Young adulthood, 20-
24 years)
• Existential Question: Can I Love?
• This conflict is emphasized around the age of 20. At the
start of this stage, identity vs. role confusion is coming
to an end, though it still lingers at the foundation of the
stage. Young adults are still eager to blend their
identities with friends. They want to fit in. Erikson
believed we are sometimes isolated due to intimacy. We
are afraid of rejections such as being turned down or
our partners breaking up with us. He argues that
Intimacy has a counterpart:

• Distantiation: the readiness to isolate and if necessary,
to destroy those forces and people whose essence seems
dangerous to our own, and whose territory seems to
encroach on the extent of one's intimate relations.
• Once people have established their identities, they are
ready to make long-term commitments to others. They
become capable of forming intimate, relationships (e.g.
through close friendships or marriage) and willingly
make the sacrifices and compromises that such
relationships require. If people cannot form these
intimate relationships – perhaps because of their own
needs, a sense of isolation may result.

Dental application
• At this stage external appearances are very important
as it helps in attainment of intimate relation. Young
adults seek orthodontic Rx to correct their dental
appearances and this characterized as internal
motivation. But alteration of appearances can also
interfere with previously established relations, so the
Rx options must be fully explained to and discussed
with young adults.

Care: Generativity vs. Stagnation (Middle
adulthood, 25-64 years)
• Existential Question: Can I Make My Life Count?
• Generativity is the concern of guiding the next
generation. Socially-valued work and disciplines are
expressions of generativity.
• The adult stage of generativity has broad application
to family, relationships, work, and society.

• When a person makes a contribution during this
period, perhaps by raising a family or working toward
the betterment of society, a sense of generativity- a
sense of productivity and accomplishment results. In
contrast, a person who is self-centered and unable or
unwilling to help society move forward develops a
feeling of stagnation- a dissatisfaction with the
relative lack of productivity.

Central tasks of middle adulthood
• Express love through more than sexual contacts.
• Maintain healthy life patterns.
• Develop a sense of unity with mate.
• Help growing and grown children to be responsible adults.
• Accept children's mates and friends.
• Create a comfortable home.
• Be proud of accomplishments of self and mate/spouse.
• Achieve mature, civic and social responsibility.
• Adjust to physical changes of middle age.
• Use leisure time creatively.

• Wisdom: Ego Integrity vs. Despair (Late adulthood,
65-death)
• Existential Question: Is it OK to Have Been Me?
• As we grow older and become senior citizens we tend
to slow down our productivity and explore life as a
retired person. It is during this time that we contemplate
our accomplishments and are able to develop integrity
if we see ourselves as leading a successful life. If we
see our life as unproductive, or feel that we did not
accomplish our life goals, we become dissatisfied with
life and develop despair, often leading to depression
and hopelessness.

• The final developmental task is retrospection: people
look back on their lives and accomplishments. They
develop feelings of contentment and integrity if they
believe that they have led a happy, productive life. They
may instead develop a sense of despair if they look
back on a life of disappointments and unachieved goals.
• This stage can occur out of the sequence when an
individual feels they are near the end of their life (such
as when receiving a terminal disease diagnosis).
• Erikson, Erik (1956). "The problem of ego identity"
Journal of the American Psychoanalytic Association 4:
56–121

Merits
• Based on age wise classification of an individual,
hence easy to apply at any stage of development.
• Simple and comprehensive to understand.
Demerits
• Based on extreme ends of personality.
• He did no statistical research to generate his theories,
and it is very hard to test his theories in order to
validate them.

Piaget’s Theory
• The first “cognitive” theory, developed by Jean Piaget
beginning about 1920.
• He observed and described children at different ages.
• His theory is very broad, from birth through
adolescence, and includes concepts of language,
scientific reasoning, moral development, and
memory.

• Piaget called his approach as “Genetic
epistemology”.
• Epistemology is the study of nature and acquisition of
knowledge.
• Genetic in the sense that is focussed on origins
(genesis) and development (not to genes or
hereditary).
• Cognition refers to knowing and understanding.

Piaget’s assumptions about children
• Children construct their own knowledge in response
to their experiences.
• Children learn many things on their own without the
intervention of older children or adults.
• Children are intrinsically motivated to learn and do
not need rewards from adults to motivate learning.

• Piaget’s theory is often described as a constructivist
view. According to constructivists, people interpret
their environments and experiences in light of the
knowledge and experiences they already have. People
do not simply take in an external reality and develop
an unchanged, exact mental copy of objects or events.
Instead, they build (or “construct”) their own
individual understandings and knowledge.

• For Piaget, the essential building block for cognition is
the schema. A schema is an organized pattern of action
or thought. It is a broad concept and can refer to
organized patterns of physical action (such as an infant
reaching to grasp an object), or mental action (such as a
high school student thinking about how to solve an
algebra problem).
• As children interact with the environment, individual
schemas become modified, combined, and reorganized
to form more complex cognitive structures.

• A schema describes both the mental & physical
actions involved in knowing and understanding.
• They are categories that help us interpret &
understand the world.
• According to Piaget, schema includes both a category
of knowledge and the process of obtaining that
knowledge.
• With experience new information is used to modify
existing schema.

For eg:
• A schema for an animal like Cow.
• If child has only seen white cows,
he might believe that all cows are
white with 4 legs.
• When child encounters a black
cow, the child will modify the
existing schema.

• As children mature, these structures allow more
complex and sophisticated ways of thinking. These,
in turn, allow them to interact in qualitatively
different ways with their environment. For eg, a little
girl develops a schema for noticing similarities
between objects (we’ll call this a “compare” schema)
and a separate one for noticing differences (a
“contrast” schema). Gradually, she coordinates and
combines the 2 into a single cognitive structure that
allows her to compare and contrast objects at the
same time.

• When she encounters a new object, she uses this
coordinated cognitive structure to develop a fuller
understanding of the object.
• Piaget believed that extensive interaction with the
environment is absolutely essential for each person’s
cognitive development.

• Though Piaget acknowledged that biological
maturation sets the general limits within which
cognitive development occurs, he placed much more
emphasis on the role of the environment. Children
who have severely limited interactions with their
environments simply will not have the opportunities
to develop and reorganize their cognitive structures so
as to achieve mature ways of thinking.

Nature vs. Nurture
• Nature and nurture interact to produce cognitive
development.
Nature: maturation of brain and body; ability to
perceive, learn, act; motivation
Nurture:
• Adaptation: Children respond to the demands of the
environment in ways that meet their own goals.
• Organization: Children integrate particular
observations into a body of coherent knowledge.

• The process of adaptation is made up of 3 functional
variants.
• Assimilation concerns with observing, recognizing,
taking up an object and relating it with earlier
experiences OR categories or the process of taking in
new information into the previously existing
schemas. It is a natural process. For eg seeing a cow
and labelling it as cow.

• Accommodation accounts for changing concepts and
strategies as a result of new assimilated information
OR changing or altering our existing schemas in the
light of new knowledge.
• New schemas may also be developed in this process.
• It is an acquired process.
• For eg seeing a black cow and accepting it into the
cow schema.

• Equilibration refers to changing basic assumptions
following adjustments in assimilated knowledge so
that fact fits better. Piaget believed that the child tries
to balance between assimilation and accommodation,
which is achieved through a mechanism called
Equilibriation.

The Sensorimotor Period (birth to 2 years)
• During the sensorimotor stage, infants and toddlers
"think" with their eyes, ears, hands, and other
sensorimotor equipment. Piaget said that a child’s
cognitive system is limited to motor reflexes at birth,
but the child builds on these reflexes to develop more
sophisticated procedures. They learn to generalize
their activities to a wider range of situations and
coordinate them into increasingly lengthy chains of
behaviour.

Dental applications
• Child begins to interact with the environment and can
be given toys while sitting on the dental chair in
his/her hand.

Preoperational Thought (2 to 6/7 years)
• At this age, according to Piaget, children acquire
representational skills in the area of mental imagery,
and especially language. During 2nd year, children are
capable of discovering a hidden object even after it
has been removed from one hiding place to another
(Object Permanence achieved).

• Identity concept
• Lack of conservation ,
• Egocentrism,
• Centration, &
• Irreversibility - are hallmarks of this stage.

• Identity concept:It is an idea that characteristics like
length of an object should not change just because
object has been moved to a new location.
• Lack of Conservation: Conservation is the awareness
that physical quantities remains constant in spite of
changes in their shape or appearance. Eg: A 5 yr old
may think that a sandwich cut into 4 pieces has more
to eat than a sandwich cut into 2!! (lack of
conservation of quantity).

If same volume of water poured in shallow & wide ; and
tall & narrow glass; child may think the taller the water
level more the volume of water (lack of conservation of
volume)

• EgoCentrism: The child’s world is egocentered or has
limited ability to share another person’s viewpoint.
• His view of the world is animistic, thus he cannot
distinguish what is real from what is not real.
• For eg: he may feel that dentist or the assistant is the
cause of pain just because that person was present at
the time of painful experience.

• They tend to assume that others see the world just as
they see it.
• For eg: Ask child show to pictures in a book. He
shows you only the cover page as it faces you but
continues to show pictures. He doesn’t know that you
cannot see it. He thinks you can see it if she can. It
does not mean selfishness; instead- it refers to an
intellectual limitation

• Centration:2-7 yrs old child’s thought is also centered
only on one salient aspect of the problem or one feature
of a multi-faceted experience is emphasized in the
child’s perception.
• For eg: a 3 yr old child may identify a series of pictures
as cow if each of these animals have horns like cow; in
fact that is one thing child has centered in his
recognition of cow.
• A child can center on one salient aspect of dental
appointment; obviously centering on counting teeth etc
is better than centering on needles, pain!!!

• Irreversibility :It is the inability to envision
reversing an action. Eg: Child cannot think about
what will happen if the water is poured back into
the original beaker.

Dental applications
• Constructivism- child likes to explore things and
make own observations. Eg: child surveys the dental
chair, airway syringe.
• Cognitive equilibrium- child is explained about
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.

Concrete Operations (6/7 to 11/12 years)
• As opposed to preoperational children, children in this
stage are able to take into account another person’s
point of view and consider more than one perspective
simultaneously, with their thought process being more
logical, flexible, and organized than in early childhood.
They can also represent transformations as well as
static situations.
• Although they can understand concrete problems,
Piaget would argue that they cannot yet contemplate or
solve abstract problems, and that they are not yet able
to consider all of the logically possible outcomes.

• They develop qualities of decentration &
reversibility.
• Animism declines.
• Serration: Increased level of intellectual
development is seen.
• Child is able to classify objects according to shape,
size, color and consistency.This ability is called
serration.

Dental applications
• In this stage instructions must be illustrated with
concrete objects:
• Eg: “now wear your retainer every night and be sure
to keep it clean” is too abstract for them.
• “this is your retainer. Put it in your mouth like this
and take it out like this. Brush it like this with an old
toothbrush like this to keep it clean”.
• At the end of this stage child is able to express his
pain like an adult would.

Formal Operations (11/12 to adult)
• Persons who reach the formal operation stage are
capable of thinking logically and abstractly. They can
also reason theoretically. Piaget considered this the
ultimate stage of development, and stated that
although the children would still have to revise their
knowledge base, their way of thinking was as
powerful as it would get.

• At this stage child’s thought process has become
similar to that of an adult and can understand the
concepts of health diseases and preventive
management and he can be and should be treated as
an adult. The child can reason a hypothetical problem
and do a systematic search for solution.
• Instead of solely relying on past experiences, they
begin to consider possible outcomes and
consequences of actions. This type of thinking is
important in long term planning.

• Imaginary audience (David Elkind): the adolescents
feel they are constantly on stage, being observed &
criticized by those around them.

• This imaginary audience has powerful influence on
young adolescents, making them quite self-conscious
& susceptible to peer influence eg: orthodontic Rx.
• 2nd phenomenon “Personal fable” (Elkind):
• In this adolescents feel they are unique.
• Eg: He may drive too fast, thinking he is unique.

Dental applications
• Peer influence and abstract thinking increase.
• This can play an important role in orthodontic
appliances and braces. Acceptance from peers can be
used for motivation of dental Rx.

How does cognitive change take place?
• According to Piaget, development is driven by the
process of equilibration.
• Piaget suggested that equilibration takes place in 3
phases.
• First, children are satisfied with their mode of thought
and therefore are in a state of equilibrium. Then, they
become aware of the shortcomings in their existing
thinking and are dissatisfied (i.e., are in a state of
disequilibration and experience cognitive conflict).

• Last, they adopt a more sophisticated mode of
thought that eliminates the shortcomings of the old
one (i.e., reach a more stable equilibrium)
• Flavell, John H. (1999). : Children’s knowledge about
the mind. cognitive development.Annual Review of
Psychology, p. 21(16)
• Garmston, Robert & Wellman, Bruce (1994, April).
Insights from constructivist learning
theory.Educational Leadership, 51 (7), 84-85.

Criticisms of Piaget’s Theory
• Children’s thinking is not as consistent as the stages
suggest.
• Infants and young children are more competent than
Piaget recognized.
• Piaget understates the social components of cognitive
development.
• Piaget was better at describing processes than
explaining how they operate.
• Overestimates age differences in thinking.

Vygotsky’s Sociocultural View of Cognitive
Development
• Not everyone was satisfied with Piaget’s account of
cognitive development. Aside from the evidence
against grand stages in cognitive development, some
theorists and practitioners have long felt that Piaget’s
account does not adequately consider one very
important influence on cognition: the child’s social
environment. Lev Semenovich Vygotsky is one theorist
who gave the role of social interaction and culture a
central place in his account of cognitive development.

Conclusion
• An understanding of child development is essential
because it allows us to fully appreciate the cognitive,
emotional, physical, social, and educational growth
that children go through from birth and into early
adulthood.

THUS WE AS PEDODONTISTS.........
• Know the child patients better.
• Understand behaviour problems psychologically.
• Deliver dental services in a meaningful & effective
way.
• Establish effective communication & gain
confidence.
• Teach the parent & child the importance of primary &
preventive care.

References
• Kaplan and Sadock’s comprehensive textbook of
psychiatry- 9th edition.
• Freud, S. (1920). Beyond the pleasure principle. SE,
18: 1-64.
• Freud, S. (1923). The ego and the id. SE, 19: 1-66.
• Dewey, R.A. (2007) “Freud’s Theory.” Psychology:
An Introduction. Ch 11, Pt. II.
• Freud, A. (1937). The Ego and the Mechanisms of
Defense, London: Hogarth Press and Institute of
Psycho-Analysis.

• Freud, S. (1894). The neuro-psychoses of defence. SE,
3: 41-61.
• Freud, S. (1896). Further remarks on the neuro-
psychoses of defence. SE, 3: 157-185.
• Charles Rycroft, A Critical Dictionary of
Psychoanalysis (London 1995) p. 60
• Erikson, Erik (1956). "The problem of ego identity"
Journal of the American Psychoanalytic Association 4:
56–121
• Flavell, John H. (1999). : Children’s knowledge about
the mind. cognitive development. Annual Review of
Psychology, p. 21(16)

• Garmston, Robert & Wellman, Bruce (1994, April).
Insights from constructivist learning
theory.Educational Leadership, 51 (7), 84-85.
• Textbook of Pedodontics- Shobha Tandon ,2nd edition
• Comprehensive preventive dentistry-Nikhil Marwah.

Theories of learning and development of behavior
• hierarchy of needs by Maslow (1954)
• social learning theory by Bandura (1963)
• classical conditioning by Pavlov (1927)
• operant conditioning by Skinner (1938)
• Conclusion
• References

• Maslow's hierarchy of needs- proposed by Abraham
Maslow in his 1943 paper "A Theory of Human
Motivation" in Psychological Review. Maslow
subsequently extended the idea to include his
observations of humans' innate curiosity.
• His theories parallel many other theories of human
developmental psychology, some of which focus on
describing the stages of growth in humans.

• It is a description of the needs that motivate human
behaviour.
• He proposed 5 different kinds of human needs,
beginning with the most basic: survival.
Physiological needs, such as food and shelter, are
followed by needs related to safety.

• Next, there are needs of love and belonging. 4th ,
humans have needs of esteem, such as the need for
being respected. The final need in the hierarchy is the
need for self-actualization (fulfilling one's potential).
The hierarchy suggests that basic needs must be met
prior to less basic needs; for eg, a starving person will
seek food before self-actualization.

An interpretation of Maslow's hierarchy of needs,
represented as a pyramid with the more basic needs at
the bottom

• The most fundamental and basic 4 layers of the
pyramid contain what Maslow called "deficiency
needs" or "d-needs": esteem, friendship and love,
security, and physical needs. If these "deficiency
needs" are not met – with the exception of the most
fundamental (physiological) need – there may not be
a physical indication, but the individual will feel
anxious and tense.

• Maslow's theory suggests that the most basic level of
needs must be met before the individual will strongly
desire (or focus motivation upon) the secondary or
higher level needs. He also coined the term
Metamotivation to describe the motivation of people
who go beyond the scope of the basic needs and
strive for constant betterment.

Physiological needs
• They are the physical requirements for human
survival. If these requirements are not met, the human
body cannot function properly and will ultimately
fail. They are thought to be the most important; they
should be met first.
• Air, water, and food are metabolic requirements for
survival in all animals, including humans. Clothing
and shelter provide necessary protection from the
elements.

Safety needs
• With their physical needs relatively satisfied, the
individual's safety needs take precedence and
dominate behavior. In the absence of physical safety –
due to war, natural disaster, family violence,
childhood abuse, etc. – people may (re-)experience
post-traumatic stress disorder or transgenerational
trauma.

• In the absence of economic safety – due to economic
crisis and lack of work opportunities – these safety
needs manifest themselves in ways such as a
preference for job security, grievance procedures for
protecting the individual from unilateral authority,
savings accounts, insurance policies, reasonable
disability accommodations, etc

• This level is more likely to be found in children
because they generally have a greater need to feel
safe.
Safety and Security needs include:
• Personal security
• Financial security
• Health and well-being
• Safety net against accidents/illness and their adverse
impacts

Love and belonging
• After physiological and safety needs are fulfilled, the
3rd level of human needs is interpersonal and involves
feelings of belongingness.. This need is especially
strong in childhood and can override the need for
safety as witnessed in children who cling to abusive
parents.

• Deficiencies within this level of Maslow's hierarchy –
due to hospitalism, neglect, shunning, ostracism, etc.
can impact the individual's ability to form and
maintain emotionally significant relationships in
general, such as:
• Friendship
• Intimacy
• Family

• According to Maslow, humans need to feel a sense of
belonging and acceptance among their social groups,
regardless if these groups are large or small. For eg,
some large social groups may include clubs, co-
workers, religious groups, professional organizations,
sports teams, and gangs. Egs of small social
connections include family members, intimate
partners, mentors, colleagues, and confidants.

• Humans need to love and be loved – both sexually
and non-sexually – by others.
• Many people become susceptible to loneliness, social
anxiety, and clinical depression in the absence of this
love or belonging element. This need for belonging
may overcome the physiological and security needs,
depending on the strength of the peer pressure.

Esteem
• It presents the typical human desire to be accepted
and valued by others. People often engage in a
profession or hobby to gain recognition. These
activities give the person a sense of contribution or
value. Low self-esteem or an inferiority complex may
result from imbalances during this level in the
hierarchy. People with low self-esteem often need
respect from others; they may feel the need to seek
fame or glory.

• However, that will not help the person to build their
self-esteem until they accept who they are internally.
Psychological imbalances such as depression can
hinder the person from obtaining a higher level of
self-esteem or self-respect.
• Maslow noted 2 versions of esteem needs: a "lower"
version and a "higher" version.

• The "lower" version is the need for respect from
others. This may include a need for status,
recognition, fame, prestige, and attention. The
"higher" version manifests itself as the need for self-
respect. For eg, the person may have a need for
strength, competence, mastery, self-confidence,
independence, and freedom. This "higher" version
takes precedence over the "lower" version because it
relies on an inner competence established through
experience.

• Deprivation of these needs may lead to an inferiority
complex, weakness, and helplessness.
• Maslow states that while he originally thought the
needs of humans had strict guidelines, the
"hierarchies are interrelated rather than sharply
separated". This means that esteem and the
subsequent levels are not strictly separated; instead,
they are closely related.

Self-actualization
• "What a man can be, he must be."This quotation
forms the basis of the perceived need for self-
actualization. This level of need refers to what a
person's full potential is and the realization of that
potential. Maslow describes this level as the desire to
accomplish everything that one can, to become the
most that one can be. Individuals may perceive or
focus on this need very specifically.

• For eg, one individual may have the strong desire to
become an ideal parent. In another, the desire may be
expressed athletically. For others, it may be expressed
in paintings, pictures, or inventions. As previously
mentioned, Maslow believed that to understand this
level of need, the person must not only achieve the
previous needs, but master them.

• The term "Self-actualization" may not universally
convey Maslow's observations; this motivation refers
to focusing on becoming the best person that one can
possibly strive for in the service of both the self and
others. It might not properly portray the full extent of
this level; quite often, when a person is at the level of
self-actualization, much of what they accomplish in
general may benefit others or, "the greater self".

Criticism
• Little evidence for the ranking of needs that Maslow
described or for the existence of a definite hierarchy
at all.
• The order in which the hierarchy is arranged (with
self-actualization described as the highest need) has
been criticized as being ethnocentric.
• It fails to illustrate and expand upon the difference
between the social and intellectual needs of those
raised in individualistic societies.

• The position and value of sex on the pyramid has also
been a source of criticism. It lists sex solely from an
individualistic perspective. For eg, sex is placed with
other physiological needs which must be satisfied
before a person considers "higher" levels of
motivation. This placement of sex neglects the
emotional, familial, and evolutionary implications of
sex within the community, although others point out
that this is true of all of the basic needs.

Changes to the hierarchy by circumstance
• The higher-order (self-esteem and self-actualization)
and lower-order (physiological, safety, and love)
needs classification of Maslow's hierarchy of needs is
not universal and may vary across cultures due to
individual differences and availability of resources in
the region or geopolitical entity/country. Changes
regarding the importance and satisfaction of needs
from the retrospective peacetime to the wartime due
to stress varied significantly across cultures.

• (the US vs. the Middle East). For the US citizens,
there was only one level of needs since all needs were
considered equally important. With regards to
satisfaction of needs during the war, in the US there
were three levels: physiological needs, safety needs,
and psychological needs (social, self-esteem, and
self-actualization).

• During the war, the satisfaction of physiological
needs and safety needs were separated into 2
independent needs while during peacetime, they were
combined as one. For the people of the Middle East,
the satisfaction of needs changed from three levels to
two during wartime.
• Maslow, A.H. (1943). A theory of human motivation.
Psychological Review, 50(4), 370–96.
• Maslow, A (1954). Motivation and personality. New
York, NY: Harper. p. 236

Merits
• Based on totality of personality development.
Demerits
• Theory is difficult and impractical to apply in
children in dental situations as the child has an ever
changing personality.

• Social learning theory integrated behavioral and
cognitive theories of learning in order to provide a
comprehensive model that could account for the wide
range of learning experiences that occur in the real
world. As initially outlined by Bandura and Walters in
1963 and further detailed in 1977,key tenets of social
learning theory are as follows:
• Learning is not purely behavioral; rather, it is a
cognitive process that takes place in a social context.

• Learning can occur by observing a behavior and by
observing the consequences of the behavior
(vicarious reinforcement).
• Learning involves observation, extraction of
information from those observations, and making
decisions about the performance of the behavior
(observational learning or modeling).

• Thus, learning can occur without an observable
change in behavior.
• Reinforcement plays a role in learning but is not
entirely responsible for learning.
• The learner is not a passive recipient of information.
Cognition, environment, and behavior all mutually
influence each other (reciprocal determinism).

• This theory draws heavily on the concept of
modeling, or learning by observing a behavior.
Bandura outlined 3 types of modeling stimuli:
Live model
• an actual person is demonstrating the desired
behavior.
Verbal instruction
• an individual describes the desired behavior in detail
and instructs the participant in how to engage in the
behavior.

Symbolic
• modeling occurs by means of the media, including
movies, TV, internet, literature, and radio. Stimuli can
be either real or fictional characters.
• Exactly what information is gleaned from observation
is influenced by the type of model, as well as a series
of cognitive and behavioral processes, including:

Attention
• In order to learn, observers must attend to the
modeled behavior. Attention is impacted by
characteristics of the observer (e.g., perceptual
abilities, cognitive abilities, arousal, past
performance) and characteristics of the behavior or
event (e.g., relevance, novelty, affective valence, and
functional value).

Retention
• In order to reproduce an observed behavior, observers
must be able to remember features of the behavior.
Again, this process is influenced by observer
characteristics (cognitive capabilities, cognitive
rehearsal) and event characteristics (complexity ).

Reproduction
• To reproduce a behavior, the observer must organize
responses in accordance with the model. Observer
characteristics affecting reproduction include physical
and cognitive capabilities and previous performance.
Motivation
• The decision to reproduce (or refrain from reproducing)
an observed behavior is dependent on the motivations
and expectations of the observer, including anticipated
consequences and internal standards.

• An important factor in this theory is the concept of
reciprocal determinism. This notion states that just as
an individual’s behavior is influenced by the
environment, the environment is also influenced by
the individual’s behavior.
• For eg, a child who plays violent video games will
likely influence their peers to play as well, which then
encourages the child to play more often.

• This could lead to the child becoming desensitized to
violence, which in turn will likely affect the child’s
real life behaviors.
• Bandura, A.; Ross, D.; Ross, S.A. (1961).
"Transmission of aggression through the imitation of
aggressive models". Journal of Abnormal and Social
Psychology 63 (3): 575–582.
• Bandura, Albert (1965). "Influence of models'
reinforcement contingencies on the acquisition of
imitative responses". Journal of Personality and
Social Psychology 1 (6): 589–595.

• Classical conditioning was 1st identified and
developed by a Russian physiologist, Ivan Pavlov
(1927/1960). This phenomenon is widely considered to
be the most fundamental form of learning.
• Pavlov was awarded the Nobel Prize in Physiology and
Medicine for his research on the digestive system of
dogs. To pursue his digestion research, Pavlov
developed a procedure for surgically implanting a tube,
called a fistula, into living animals. This allowed him to
collect and measure digestive secretions, such as those
released in the stomach or the mouth.

• Pavlov or one of his assistants would place meat into
the mouth of a dog and then measure the amount of
saliva that passed through a salivary fistula implanted
for collecting saliva in a test tube pasted onto the
outside of a dog's cheek.
• He noticed that his dogs began to salivate upon
merely seeing Pavlov's lab assistant entering the room
or getting out the food pans, even before any food
was presented.

• Pavlov discontinued his digestion research and
focused exclusively on this new and curious
phenomenon he originally called ''psychic reflexes.''
• Through further investigation he discovered that his
psychic reflexes developed through a process he
could control and manipulate.
• He called this process ''conditioning'' because it
defined the conditions under which reflexes would
occur to previously ineffective, or ''reflex-neutral''
stimuli.

• Pavlov began to substitute highly specific
manipulated stimuli as alternatives to the less
controlled entry of his lab assistants or presentations
of empty food pans. He used specific and controllable
stimuli as the sound or even the specific rate, of a
metronome's ticking.
• A stimulus is 1st tested to assure it is ''neutral,'' in that
it does not elicit salivation. Then that NS is presented
along with a stimulus, such as food, that is known to
elicit salivation.

• After a few repetitions of this temporal pairing of the
two (neutral and eliciting) stimuli, the previously NS
is found to be no longer neutral, but now will elicit
salivation when presented by itself.
• Classical conditioning has applications in therapeutic
environments. For eg, these procedures are
fundamental in our understanding and Rx of phobias.

Variables in Classical Conditioning
• Independent variable is the unconditional stimulus (UCS),
such as food. Its associated dependent variable is the
response it elicits, called the unconditional response (UCR).
In Pavlov's typical research this UCR was salivation.
• A 2nd independent variable, as it exists prior to conditioning,
is called the neutral stimulus (NS), but when paired
successive times with the presentation of the UCS, this NS
gradually acquires the function of also eliciting a response
similar to the UCR, and in this state the stimulus is called
the conditional stimulus (CS).

Principles involved in the process
• Acquisition: learning a new response from the
environment by conditioning. Acquisition phase is
the consistent pairings of CS and the UCS that
produces a CR.
• Generalization: Occurs when the process of
conditioning is evoked by a band of stimuli centered
around a specific CS. A stimulus similar to training
stimulus results in a response.

• Occurs when only small differences in the stimulus
and original CS. Eg: a child who has had a painful
experience with a doctor in a white coat always
associates any doctor in white coat with pain.
• Discrimination: The opposite of generalization,
discrimination happens when a CR does not occur
when there is a difference between the presented
stimulus and the original CS.

• Eg: if the child is exposed to clinic settings which
are different to those associated with painful
experiences the child learns to discriminate between
the 2 clinics and even the generalized response to any
office will be extinguished.
• Extinction: of the conditioned behavior results if the
association between the CR and UCR is not
reinforced. In the above mentioned eg subsequent
visits to the doctor without any unpleasant experience
result in extinction of fear.

Extinction and Spontaneous Recovery
Pavlov investigated what would happen if the CS
were presented for a number of trials without the
presence of the UCS used for conditioning, but only
after successful conditioning had already been
established. He quickly discovered that the CR
diminishes, and eventually disappears. This procedure
is called extinction.

• The critical elements in the gradual disappearance of
the CR is the occurrence of a CS (for eg, a
metronome) that is no longer associated with an UCS
(for eg food) after successful previous conditioning
trials. The diminished CR or its total disappearance is
extinguished behavior that Pavlov thought was
parallel to an extinguished species because it was no
longer adaptive.

• Extinction is an adaptive behavior suited to changing
circumstances and is parallel to extinction of species
when their behaviors are no longer viable for survival
that gives the procedure extinction its name.
• It might reappear briefly on subsequent testing days -
a phenomenon called spontaneous recovery, but that
also quickly disappears.

• The reappearance of a CR to the testing presentation
of a CS would occasionally occur even without
reconditioning, thus appearing to be a spontaneous
recovery of the prior conditioning effect. It is from
this reappearance that the phenomenon is called
spontaneous recovery.

Principles of classical conditioning can be used in
the following areas of human behaviour
• Developing good habits
• Breaking habits and elimination of conditioned fear
• Psychotherapy, to de-condition emotional fear
• Developing positive attitudes
Dental applications
• Sound of hand piece and sight of dentist

Systematic Desensitization
• Classical conditioning occurs naturally in our
everyday lives , result in strong conditioned
emotional responses ranging from simple fears to
even more extreme and generalized fears called
phobias. Early approaches to Rx for such phobias
thus emphasized the importance of facing the
originally feared stimulus in the absence of any
harmful or feared UCS, thus creating a forceful and
sometimes highly uncomfortable extinction process
called ''flooding''.

• Such radical procedures were sometimes referred to
as the broncobusting technique.
• So conditioning-based Rx for phobias added a more
gradual dimension to this extinction process.
• Such a gradual approach uses what is called
systematic desensitization techniques.

Operant Conditioning (instrumental learning)
• Classical conditioning doesn't explain how we
develop new skills or behaviors instrumental in
changing our external environments. That learning
process involves what is typically referred to as
instrumental, or operant, conditioning. Operant
conditioning describes how we develop behaviors
that ''operate upon the environment'' to bring about
behavioral consequences in that environment.

• Operant conditioning applies many techniques and
procedures first investigated by E. L. Thorndike
(1898) but later refined and extended by B. F. Skinner
(1938). Operant conditioning is the use of a
behavior's antecedent and/or its consequence to
influence the occurrence and form of behavior.
Operant conditioning is distinguished from classical
conditioning (respondent conditioning) in that
operant conditioning deals with the modification of
"voluntary behavior" or operant behavior.

• Operant behavior "operates" on the environment and
is maintained by its consequences, while classical
conditioning deals with the conditioning of reflexive
behaviors which are elicited by antecedent conditions.
Behaviors conditioned via a classical conditioning
procedure are not maintained by consequences.
• Skinner is regarded as the father of Operant
Conditioning, but his work was based on Thorndike’s
law of effect.

• Skinner introduced a new term into the Law of Effect
- Reinforcement. Behavior which is reinforced tends
to be repeated (i.e. strengthened); behavior which is
not reinforced tends to die out-or be extinguished (i.e.
weakened).
• Skinner studied operant conditioning by conducting
experiments using animals which he placed in a
'Skinner Box' which was similar to Thorndike’s
puzzle box.

• Operant conditioning means roughly changing of
behavior by the use of reinforcement which is given
after the desired response. Skinner identified 3 types
of responses or operant that can follow behavior.
• Neutral operants: responses from the environment
that neither increase nor decrease the probability of a
behavior being repeated.

• Reinforcers: Responses from the environment that
increase the probability of a behavior being
repeated.It can be either positive or negative.
• Punishers: Responses from the environment that
decrease the likelihood of a behavior being repeated.
Punishment weakens behavior.

• For eg, when A was young he tried smoking at
school, and if the consequence was that he got in with
the crowd he always wanted to hang out with, he
would be positively reinforced (i.e. rewarded) and
would likely to repeat the behavior. If, however, the
main consequence was that he was caught, caned,
suspended from school and his parents became
involved he would most certainly have been
punished, and he would consequently be much less
likely to smoke now.

• Reinforcement and punishment, the core tools of
operant conditioning, are either positive (delivered
following a response), or negative (withdrawn
following a response). This creates a total of 4 basic
consequences, with the addition of a 5th procedure
known as extinction(i.e. no change in consequences
following a response).

Reinforcement (strengthens behavior)
• Skinner showed how positive reinforcement worked by
placing a hungry rat in Skinner box. The box contained
a lever in the side and as the rat moved about the box it
would accidentally knock the lever. Immediately it did
so a food pellet would drop into a container next to the
lever. The rats quickly learned to go straight to the lever
after a few times of being put in the box. The
consequence of receiving food if they pressed the lever
ensured that they would repeat the action again and
again.

• Negative reinforcement (Escape): It occurs when a
behavior (response) is followed by the removal of an
aversive stimulus, thereby increasing that behavior's
frequency. Skinner showed how it worked by placing
a rat in his Skinner box and then subjecting it to an
unpleasant electric current which caused it some
discomfort.

• As the rat moved about the box it would accidentally
knock the lever. Immediately it did so the electric
current would be switched off. The rats quickly
learned to go straight to the lever after a few times of
being put in the box. The consequence of escaping
the electric current ensured that they would repeat the
action again and again.

• Skinner even taught the rats to avoid the electric
current by turning on a light just before the electric
current came on. The rats soon learned to press the
lever when the light came on because they knew that
this would stop the electric current being switched on.
• It can also be a loud noise continuously sounding
inside the rat's cage until it engages in the target
behavior, such as pressing a lever, upon which the
loud noise is removed.

• Positive reinforcement strengthens a behavior by
providing a consequence an individual finds
rewarding. For eg, if your teacher gives you a toffee
each time you complete your homework (i.e. a
reward) you are more likely to repeat this behavior in
the future, thus strengthening the behavior of
completing your homework.

• Negative reinforcement is the removal of an adverse
stimulus which is ‘rewarding’ to the animal.It
strengthens behavior because it stops or removes an
unpleasant experience.
• For eg, if you do not complete your homework you
wont be allowed for play time. You will complete
your homework to avoid it, thus strengthening the
behavior of completing your homework.

Punishment (weakens behavior)
• It is defined as the opposite of reinforcement since it is
designed to weaken or eliminate a response rather than
increase it.
• Like reinforcement, punishment can work either by
directly applying an unpleasant stimulus like a shock
after a response or by removing a potentially rewarding
stimulus, for instance, deducting someone’s pocket
money to punish undesirable behavior.
• Note: It is not always easy to distinguish between
punishment and negative reinforcement.

• Positive punishment ("Punishment by contingent
stimulation"): Occurs when a behavior (response) is
followed by a stimulus, such as introducing a shock
or loud noise, resulting in a decrease in that behavior.
Positive punishment is sometimes a confusing term,
as it denotes the "addition" of a stimulus or increase
in the intensity of a stimulus that is aversive (such as
spanking or an electric shock).

• Negative punishment (Penalty) ("Punishment by
contingent withdrawal"): Occurs when a behavior is
followed by the removal of a stimulus, such as taking
away a child's toy following an undesired behavior,
resulting in a decrease in that behavior.
• Extinction: Occurs when a behavior that had previously
been reinforced is no longer effective. For eg, a rat is
first given food many times for lever presses. Then, in
extinction, no food is given. Typically the rat continues
to press more and more slowly and eventually stops, at
which time lever pressing is said to be "extinguished."

Behavior Modification
• Behavior modification is a set of therapies /
techniques based on operant conditioning . The main
principle comprises changing environmental events
that are related to a person's behavior. For eg, the
reinforcement of desired behaviors and ignoring or
punishing undesired ones.

Critical Evaluation
• Operant conditioning fails to taken into account the
role of inherited and cognitive factors in learning, and
thus is an incomplete explanation of the learning
process in humans and animals.
• Primates often seem to solve problems in a flash of
insight rather than be trial and error learning.

• Social learning theory (Bandura) suggests that humans
can learn automatically through observation rather than
through personal experience.
• The use of animal research in operant conditioning
studies also raises the issue of extrapolation. Some
psychologists argue we cannot generalize from studies
on animals to humans as their anatomy and physiology
is different from humans, and they cannot think about
their experiences and invoke reason, patience, memory
or self-comfort.

Conclusion
• Dentistry for children can be demanding and
frustrating; at the same time, it can be enriching,
satisfying, and memorable.
• Children who display disruptive behaviors places
unique demands on a dentist, requiring him or her to
incorporate additional skills and knowledge.

• The knowledge of psychological growth &
development can provide the dentist with knowledge
of the type of behavior to expect from children of
certain ages, can aid the dentist with his work. Thus
providing an optimal experience for both.

References
• Maslow, A.H. (1943). A theory of human motivation.
Psychological Review, 50(4), 370–96.
• Maslow, A (1954). Motivation and personality. New
York, NY: Harper. p. 236
• Bandura, A.; Ross, D.; Ross, S.A. (1961).
"Transmission of aggression through the imitation of
aggressive models". Journal of Abnormal and Social
Psychology 63 (3): 575–582.

• Bandura, Albert (1965). Influence of models
reinforcement contingencies on the acquisition of
imitative responses". Journal of Personality and
Social Psychology 1 (6): 589–595
• Kaplan and Sadock’s comprehensive textbook of
psychiatry- 9th edition.
• Textbook of Pedodontics- Shobha Tandon ,2nd edition
• Comprehensive preventive dentistry-Nikhil Marwah.

Mahler’s concepts of “symbiosis” and separation-
individuation
• In a series of papers in the 1960s and 1970s, Margaret
Mahler advanced the idea that the very young human
infant is in a state of “symbiosis” with respect to his/
her experience of the mother and undergoes an
emotionally fraught process through which awareness
of separateness is achieved.

• “Separateness” marks the emergence from the sense
of oneness with the mother; “individuation,” which
accompanies it, marks the infant’s taking on
individual characteristics. This conceptualization
found its fullest expression in Mahler’s co authored
book, The Psychological Birth of the Human Infant
(Mahler, Pine, and Bergman 1975).

Child psychology

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