Child Development & Behavior Guidance Flashcards
What are Piaget’s Stages of Cognitive Development?
1) Sensorimotor
2) Preoperational
3) Concrete Operations
4) Formal operations
Age of Sensorimotor stage
0-2 years
Age of Preoperational stage
2-7 years
Age of Concrete Operations stage
7-11 years
Age of Formal Operations stage
11+ years
Description of Sensorimotor
Experience is through movement and senses
Description of Preoperational
Children use language literally and are egocentric
Description of Concrete Operations
Children can think logically but not abstractly
Description of Formal Operations
Children can think abstractly and are increasingly concerned about the opinion of others
Cognitive changes during sensorimotor stage (0-2 years)
According to Piaget:
- First two years of life
- Six discrete stages
- Object permanence
- Causality
- Symbolic play
Emotional changes during sensorimotor stage (0-2 years)
- Fear of strangers (7-12 months)
- Separation anxiety
- 6-18 months (peaking at 13 months)
- Well controlled by 36-40 months or 32-36 months
Cognitive changes during preoperational stage (2-7 years)
- Preconceptual (2-4 years)
- Mental imagery drive play and fantasy
- Centration
- Intuitive thought (4-7 years)
- Classification of objects
- Reading and writing
- Longer attention span
Emotional changes during preoperational stage (2-7 years)
- Self-control
- Develops from 3-6
- Conscience
- Aggression
- Inability to demonstrate self-control
Two types of aggression during preoperational stage
1) Instrumental aggression: to accomplish a goal
2) Hostile aggression: to harm another individual
Social changes during preoperational stage (2-7 years)
- Play (parallel play to cooperative play)
- Gender identity
- Toxic stress
Cognitive changes during concrete operations (7-12 years)
- Literacy
- Mental representations of actions
Emotional changes during concrete operations (7-12 years)
- Accepting societal norms of behavior
- Delayed gratification
- Self-directed activities
- Body image
- Peer relationships and social acceptance
Social changes during concrete operations (7-12 years)
- Positive attitude about school
- Self-confidence and motivation
- Peer influences/peer pressure
- Meaningful friendships
Cognitive changes during formal operations (12-16 years)
- Abstract thinking
- Analysis of information
- “Rebel, complainer, accuser”
- Idealism leading to disillusionment
- Introspective and analytic
- Egocentric, opinionated, argumentative
Emotional changes during formal operations (12-16 years)
- Munsen 1984:
- Attractive vs unattractive
- Loved vs unloved
- Strong vs weak
- Masculine vs feminine
- Sexuality
- Love
Social changes during formal operations (12-16 years)
- Ability to establish and maintain loving relationships
- Bullying, suicidal ideation, alcohol and substance abuse, running away from home, sexual promiscuity, gender identity, truancy
- Peer relationships
- Popularity
When does basic trust occur (Erikson)?
0-18 months
What is basic trust? (Erikson)
- Bonding between parent and child
- “Material deprivation” –> connected to “failure to thrive”
- “Separation anxiety” –> reflection of success in this stage
Failure of trust to develop results in what? (Erikson)
Mistrust
When does autonomy develop? (Erikson)
18 months to 3 years old
What is autonomy? (Erikson)
- “Terrible twos”
- Development of individual identity
- “Consistently enforced limits on behavior at this time allow the child to further develop trust in a predictable environment”
Failure of autonomy to develop results in what? (Erikson)
Shame
When does initiative occur? (Erikson)
3 to 6 years
What is initiative? (Erikson)
- Increasing autonomy, planning and pursuit
- Extreme curiosity and questioning
- Aggressive talking
- Modeling of behavior
Failure of initiative to develop results in what? (Erikson)
Guilt
When does industry develop? (Erikson)
7 to 11 years
What is industry? (Erikson)
- Academic and social skills
- Mastery of skills, competition, cooperation
- Decrease of parents as role models
- Increase of peers as influences
Failure of industry to develop results in what? (Erikson)
Inferiority
When does personal identity develop? (Erikson)
12 to 17 years
What is personal identity? (Erikson)
- Feeling of belonging
- Relationships begin to include romantic
- Sexuality - Responsibilities
- Separation from family and peer group
Failure of personal identity to develop results in what? (Erikson)
Role confusion
When does intimacy develop? (Erikson)
Young adult
What is intimacy? (Erikson)
Ability to compromise and sacrifice to maintain a relationship
Failure of intimacy to develop results in what? (Erikson)
Isolation
When does generativity develop? (Erikson)
Adult
What is generativity? (Erikson)
- Becoming a parent
- Service to community or nation
- Ensuring the success of the next generation
Failure of generativity to develop results in what? (Erikson)
Stagnation, self-indulgence, self-centered behavior
When does ego integrity develop? (Erikson)
Late adult
What is ego integrity? (Erikson)
- Adapted to gratification and disappointment
- Making the best of life
Failure of ego integrity to develop results in what? (Erikson)
Despair
Erikson’s stages of psychosocial development
- Trust vs. mistrust
- Autonomy vs. shame
- Initiative vs. guilt
- Industry vs. inferiority
- Identity vs. role confusion
- Intimacy vs. isolation
- Generativity vs. stagnation
- Ego integrity vs. despair
Basic virtue and age for trust vs. mistrust stage (Erikson)
- Hope
- 0 to 1.5 years
Basic virtue and age for autonomy vs. shame stage (Erikson)
- Will
- 1.5 to 3 years
Basic virtue and age for initiative vs. guilt stage (Erikson)
- Purpose
- 3 to 5 years
Basic virtue and age for industry vs. inferiority
- Competency
- 5 to 12 years
Basic virtue and age for identity vs. role confusion
- Fidelity
- 12 to 18 years
Basic virtue and age for intimacy vs. isolation
- Love
- 18 to 40 years
Basic virtue and age for generativity vs. stagnation
- Care
- 40 to 65 years
Basic virtue and age for ego integrity vs. despair
- Wisdom
- 65+ years
When does the motor skill of transferring objects hand to hand occur?
- Median 5.5 months
- Range 4 to 8 months
When does the motor skill of sitting alone for 30 seconds or more occur?
- Median 6.0 months
- Range 5 to 8 months
When does the motor skill of rolling from back to stomach occur?
- Median 6.4 months
- Range 4-10 months
When does the motor skill of having a neat pincer grasp occur?
- Median 8.9 months
- Range 7-12 months
When does the motor skill of standing alone occur?
- Median 11 months
- Range 9-16 months
When does the motor skill of holding crayon adaptively occur?
- Median 11.2 months
- Range 8-15 months
When does the motor skill of walking alone occur?
- Median 11.7 months
- Range 9-17 months
When does the motor skill of walking up the stairs with help occur?
- Median 16.1 months
- Range 12-23 months
When does the motor skill of walking up the stairs with both feet on each step occur?
- Median 25.8 months
- Range 19-30 months
Common characteristics of 2 year old
- Gross motor skills; just developing self-help skills
- Very attached to parent
- Plays alone; rarely shares
- Limited vocabularity
Common characteristics of 3 year old
- Less egocentric
- Likes to please
- Active imagination
- Closely attached to parent
Common characteristics of 4 year old
- Tries to impose power
- Develops small social groups
- Expansive period – reaches out from parent
- Many independent self-help skills
Common characteristics of 5 year old
- Deliberate
- Takes pride in possessions
- Relinquishes comfort objects
- Plays cooperatively with peers
Psychosocial traits and skills for 2 year old
- Geared to gross motor skills, such as running and jumping
- Likes to see and touch
- Very attached to parent
- Plays alone; rarely shares
- Has limited vocabulary; shows early sentence formation
- Becoming interested in self-help skills
Psychosocial traits and skills for 3 year old
- Less egocentric; likes to please
- Has very active imagination; likes stores
- Remains closely attached to parent
Psychosocial traits and skills for 4 year old
- Tries to impose powers
- Participates in small social groups
- Reaches out – expansive period
- Shows many independent self-help skills
- Knows “thank you” and “please”
Psychosocial traits and skills for 5 year old
- Undergoes a period of consolidation; deliberate
- Takes pride in possessions
- Relinquishes comfort objects, such as a blanket or thumb
- Plays cooperatively with peers
Social/emotional characteristics at 6 months
- Knows familiar faces and begins to know if someone is a stranger
- Likes to play with others, especially parents
- Responds to other people’s emotions and often seems happy
- Likes to look at self in mirro
Language/communication characteristics at 6 months
- Responds to sounds by making sounds
- Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds
- Responds to own name
- Makes sounds to show joy and displeasure
- Begins to say consonant sounds (jabbering with “m,” “b”)
Cognitive characteristics at 6 months
- Looks around at things nearby
- Brings things to mouth
- Shows curiosity about things and tries to get things that are out of reach
- Begins to pass things from one hand to the other
Movement/physical development characteristics at 6 months
- Rolls over in both directions (front to back, back to front)
- Begins to sit without support
- When standing, supports weight on legs and might bounce
- Rocks back and forth, sometimes crawling backward before moving forward
Social/emotional characteristics at 12 months
- Is shy or nervous with strangers
- Cries when mom or dad leaves
- Has favorite things and people
- Shows fear in some situations
- Hands you a book when he wants to hear a story
- Repeat sounds or actions to get attention
- Puts out arms or leg to help with dressing
- Play games such as “peek-a-boo” and “pat-a-cake”
Language/communication characteristics at 12 months
- Responds to simple spoken requests
- Uses simple gestures, like shaking head “no” or waving “bye-bye”
- Makes sounds with changes in tone (sounds more like speech)
- Says “mama” and “dada” and exclamations like “uh-oh!”
- Tries to say words you say
Cognitive characteristics at 12 months
- Explores things in different ways, like shaking, banging, throwing
- Finds hidden things easily
- Looks at the right picture or thing when it’s named
- Copies gestures
- Starts to use things correctly; for example, drinks from a cup, brushes hair
- Bangs two things together
- Puts things in a container, takes things out of a container
- Let’s things go without help
- Pokes with index (pointer) finger
- Follows simple directions like “pick up the toy”
Movement/physical development characteristics at 12 months
- Gets to a sitting position without help
- Pulls up to stand, wakes holding on to furniture (“cruising”)
- May take a few steps without holding on
- May stand alone
Social/emotional characteristics at 24 months
- Copies others, especially adults and older children
- Gets excited when with other children
- Shows more and more independence
- Shows defiant behavior (doing what he has been told not to)
- Plays mainly beside other children, but is beginning to include other children, such as in chase games
Language/communication characteristics at 24 months
- Points to things or pictures when they are named
- Knows names of familiar people and body parts
- Says sentences with 2 to 4 words
- Follows simple instructions
- Repeats words overheard in conversation
- Points to things in a book
Cognitive characteristics at 24 months
- Finds things even when hidden under two or three covers
- Begins to sort shapes and colors
- Completes sentences and rhymes in familiar books
- Plays simple make-believe games
- Builds towers of 4 or more blocks
- Might use one hand more than the other
- Follows two-step instructions such as “Pick up your shoes and put them in the closer”
- Names items in a picture book such as a cat, bird, or dog
Movement/physical development characteristics at 24 months
- Stands on tiptoe
- Kicks a ball
- Begins to run
- Climbs onto and down from furniture without help
- Waks up and down stairs holding on
- Throws ball overhand
- Makes or copies straight lines and circles
Social/emotional characteristics at 36 months
- Copies adults and friends
- Shows affection for friends without prompting
- Takes turns in games
- Shows concern for a crying friend
- Understands the idea of “mine” and “his” or “hers”
- Shows a wide range of emotions
- Separates easily from mom and dad
- May get upset with major changes in routine
- Dresses and undresses self
Language/communication characteristics at 36 months
- Follows instructions with 2 or 3 steps
- Can name most familiar things
- Understands words like “in,” “on,” and “under”
- Says first name, age, and sex
- Names a friend
- Says words like “I,” “me,” “we,” and “you” and some plurals (cars, dogs, cats)
- Talks well enough for strangers to understand most of the time
- Carries on a conversation using 2 to 3 sentences
Cognitive characteristics at 36 months
- Can work toys with buttons, levers, and moving parts
- Plays make-believe with dolls, animals, and people
- Does puzzles with 3 or 4 pieces
- Understands what “two” means
- Copies a circle with pencil or crayon
- Turns book pages one at a time
- Builds towers of more than 6 blocks
- Screws and unscrews jar lids or turns door handle
Movement/physical development characteristics at 36 months
- Climbs well
- Runs easily
- Pedals a tricycle
- Walks up and down stairs, one foot on each step
Social/emotional characteristics at 48 months
- Enjoys doing new things
- Plays “Mom” and “Dad”
- Is more and more creative with make-believe play
- Would rather play with other children than by himself
- Cooperates with other children
- Often can’t tell what’s real and what’s make-believe
- Talks about what she likes and what she is interested in
Language/communication characteristics at 48 months
- Knows some basic rules of grammar, such as correctly using “he” and “she”
- Sings a song or says a poem from memory such as “Itsy Bitsy Spider” or “Wheels on the Bus”
- Tells stories
- Can say first and last name
Cognitive characteristics at 48 months
- Names some colors and some numbers
- Understands the idea of counting
- Starts to understand time
- Remembers parts of a story
- Understands the idea of “same” and “different”
- Draws a person with 2 to 4 body parts
- Uses scissors
- Starts to copy some capital letters
- Plays board or card games
- Tells you what he thinks is going to happen next in a book
Movement/physical development characteristics at 48 months
- Hops and stands on one foot up to 2 seconds
- Catches a bounced ball most of the time
- Pours, cuts with supervision, and mashes own food
Social/emotional characteristics at 60 months
- Wants to please friends
- Wants to be like friends
- More likely to agree with rules
- Likes to sing, dance, and act
- Is aware of gender
- Can tell what’s real and what’s make-believe
- Shows more independence (for example, may visit a next-door neighbor by himself [adult supervision is still needed])
- Is sometimes demanding and sometimes very cooperative
Language/communication characteristics at 60 months
- Speaks very clearly
- Tells a simple story using full sentences
- Uses future tense; for example, “Grandma will be here”
- Says name and address
Cognitive characteristics at 60 months
- Counts 10 or more things
- Can draw a person with at least 6 body parts
- Can print some letters or numbers
- Copies a triangle and other geometric shapes
- Knows about things used every day, like money and food
Movement/physical development characteristics at 60 months
- Stands on one foot for 10 seconds or longer
- Hops; may be able to skip
- Can do a somersault
- Uses a fork and spoon and sometimes a table knife
- Can use the toilet on her own
- Swings and climbs
Frankl 4
- (+ +)
- Definitively positive, good rapport, interest in dental procedures, laughs, and enjoys
Frankl 3
- (+ -)
- Positive, accepts treatment but may be cautious or reserved, follows directions
Frankl 2
- (- +)
- Negative, reluctant, timid, uncooperative
Frankl 1
- (- -)
- Definitively negative, refusal of treatment, defiant, unable to cooperate
Variables influencing children’s dental behavior
- Parental anxiety
- Toxic stress
- Medical experiences
- Awareness of dental problem
- General behavior problems
Parental anxiety
- Related to child dental anxiety
- Correlated negatively with child behaviors
- Mothers more than fathers
- Greatest effect in children less than four years of age
What is toxic stress?
Stress that continues over a prolonged period and has lifelong effects.
Examples of toxic stress
- Child abuse/neglect
- Chronic exposure to drugs or violence in the home
- Parental depression or mental illness
- Economic hardship
Temperament categories
1) Activity level
2) Rhythmicity
3) Approach or withdrawal
4) Adaptability
5) Threshold of responsiveness
6) Intensity of reaction
7) Quality of mood
8) Distractability
9) Attention span and persistence
Easy temperament
- Biological regularity
- Quick adaptability to change
- Tendency to approach new situations versus withdraw
- Predominantly positive mood of mild or moderate intensity
Difficult temperament
- Biological irregularity
- Withdrawal tendencies to the new
- Slow adaptability to change
- Frequent negative emotional expressions of high intensity
Slow-to-warm-up temperament
- This category comprises withdrawal tendencies to the new
- Slow adaptability to change
- Frequent negative emotional reactions of low intensity
- Such individuals are often labeled “shy”
Parenting styles (Baumrind and expanded by Maccoby and Martin)
- Authoritarian
- Authoritative
- Permissive (initially, then expanded to below):
- Uninvolved (neglectful)
- Indulgent (permissive)
Define responsiveness (parenting style)
- Warmth or supportiveness
- The extent to which parents intentionally foster individuality, self-regulation, and self-assertion by being attuned, supportive, and acquiescent to children’s special needs and demands
Define demandingness (parenting style)
- Behavioral control
- “The claims parents make on children to become integrated into the family whole, by their maturity demands, supervision, disciplinary efforts and willingness to confront the child who disobeys”
Authoritarian
- High demandingness, lower responsiveness
- They are obedience- and status-oriented, and expect their orders to be obeyed without explanation
- Well-ordered, structured environments with clear rules
- Non-authoritarian directive vs authoritarian-directive
Ideal parenting style
Authoritarian
Authoritative
- High demandingness, high responsiveness
- They monitor and impart clear standards for their children’s conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive. They want their children to be assertive as well as socially responsible, and self-regulated as well as cooperative.
Uninvolved
- Low demandingness, low responsiveness
- May include rejecting-neglecting and neglectful
Indulgent/permissive
- Low demandingness, high responsiveness
- They are non-traditional and lenient, do not require mature behavior, allow considerable self-regulation, and avoid confrontation
- Democratic vs nondirective
Behavior shaping
- State the goal or task
- Explain the necessity
- Divide the explanation for the procedure
- Give explanations at child’s level of understanding
- Use successive approximation
- Reinforce appropriate behavior
- Disregard minor inappropriate behavior
Operant conditioning: pleasant stimulus
Probability of response increases:
- Pleasant stimulus introduced
- Positive reinforcement or reward
Probability of response decreases:
- Pleasant stimulus withdrawn
- Omission or time-out
Operant conditioning: unpleasant stimulus
Probability of response increases:
- Unpleasant stimulus withdrawn
- Negative reinforcement or escape
Probability of response decreases:
- Unpleasant stimulus introduced
- Punishment
Positive pre-visit imager
- Provide children and parents with positive visual imagery about what to expect during dental appointment prior to visit
- Can be achieved via website or mailing
- Indications/contraindications: all patients/none
- Level of evidence: Good
Direct observation/modeling
- Patient observes another patient exhibiting cooperative behavior during dental treatment
- Can be achieved via live patient model or video
- Indications/contraindications: all patients/none
Level of evidence: Fair
Tell-show-do
- Tell: verbal explanation of procedure in child-friendly, age appropriate terms
- Show: allow child to physically interact with aspects of procedure (i.e. instruments) via senses
- Do: perform procedure
- Example: tell child you will tickle his teeth with your electric tooth brush; show child prophy cup on his finger; perform rubber cup prophy
- Indications/contraindications: all patients/hearing impaired
- Level of evidence: weak
Ask-tell-ask
- Ask questions to assess patient’s feelings about procedure.
- Tell patient information in language they can understand.
- Ask about patient/parent’s understanding.
- Example: “Do you know why you are here today?” Explain planned treatment, “Do you have any questions about your visit today?”
- Indications/contraindications: any patient or parent/an upset or angry parent will not be able to comprehend and remember information
- Level of evidence: Weak
Voice control
- Alteration of voice in tone, volume, and pace to influence behavior
- Goal is to gain child’s attention in an effort to extinguish negative behaviors and re-establish communication between dentist and child
- Typically used to describe assertive voice modulation which may be aversive to some parents
- Indications/contraindications: any patient/hearing impaired
- Level of evidence: weak
Positive reinforcement
- Giving appropriate social feedback (facial expression, tone of voice, appropriate physical contact) to reward desired behaviors
- Praise should be specific to desired behavior (i.e. You are doing a great job keeping your hands on your belly)
- Indications/contraindications: any patient/none
- Level of evidence: fair
Distraction
- Diverting patient’s attention from what may be perceived as an unpleasant procedure
- Verbal: talking with child about favorite sport during injection
- Audio/visual: music or TV (most effective when use is contingent on cooperation and not unlimited)
- Physical: gently shaking cheek during injection
- Indications/contraindications: any patient/none
- Level of evidence: Excellent
Nonverbal
- Reinforcement and guidance of behavior through appropriate contact, posture, facial expression, and body language
- Example: sit in chair to greet young patients; reassuring pat on shoulder
- Indications/contraindications: any patient/none
- Level of evidence: fair
Memory restructuring
- Behavioral approach to reframe or reshape memories associated with negative experience (i.e. local anesthesia) by suggesting information after event has taken place
- Involves four components: visual reminders, positive verbal reinforcement, concrete examples, sense of accomplishment
- Indications/contraindications: any patient/none
- Level of evidence: fair
Parental presence/absence
- Utilizing presence or absence of parent to gain the child’s cooperation
- Most common technique involves a previously cooperative child who becomes uncooperative and practitioner asks parent to leave operatory until child becomes compliant
- Parents desire to be present; parents who are informed and consent to this technique prior to its use AR Elmore likely to comply with the dentist’s requests
- Indications/contraindications: any attention who has potential to be co-operative/parents who are unwilling or unable to extend effective support; a child unable to understand that parent’s presence is contingent on cooperation
- Level of evidence: fair
Advanced behavior guidance techniques
- Protective stabilization
- General anesthesia
Protective stabilization
- Restriction of patient’s freedom of movement, with or without patient’s permission, to decrease risk of injury while allowing safe completion of treatment
- Active: involves another person
- Passive: involves device
Indications/contraindications to protective stabilization
Indications:
- Uncooperative child in need of urgent care
Contraindications:
- Sedated patients/cooperative patients
- Patients who cannot be safely immobilized physically or psychologically
- Practitioner convenience
Protective stabilization information
- Potential serious consequences
- Separate informed consent required
- Appropriate documentation required
Basic/communicative behavior guidance techniques
1) Positive pre-visit imager
2) Direct observation/modeling
3) Tell-show-do
4) Ask-tell-ask
5) Voice control
6) Positive reinforcement
7) Distraction
8) Nonverbal
9) Memory restructuring
10) Parental presence/absence
Alternative communicative techniques
1) Escape
2) Hypnosis
3) Guided imagery
4) Humor
5) Deferred care/active surveillance
Escape
- Brief, intermittent breaks from treatment
- Contingent: breaks given to reward cooperative behavior
- Noncontingent: breaks given at fixed intervals
- Indications/contraindications: any patient/none
- Level of evidence: fair
Hypnosis
- State of mind induced through suggestions
- Indications/contraindications: any attention/patients without appropriate cognitive ability
- Level of evidence: Excellent
Guided imagery
- Child instructed to select a favorite and pleasant image and to visualize it; pleasant image is reinforced by comments from dentist
- Encourage child to imagine pleasant image: “What would you do if you were at the beach right now? Imagine feeling the sand in your hands.”
- Indications/contraindications: any patient/patients without appropriate cognitive ability to imagine or visualize images
- Level of evidence: Fair
Humor
- Playing with words, mis-naming objects, jokes
- Example: “Open as big as a pig!”
- Indications/contraindications: any patient/none
- Level of evidence: Weak
Deferred care/active surveillance
- Balancing urgency of care against advanced behavior guidance techniques by using preventive therapeutics until child is cooperative or disease dictates prompt treatment
- Must explain the risks, benefits, and alternatives to deferred treatment and obtain consent; IRT, fluoride, increased recalls
- Indications/contraindications: Any patient/pain or emergency treatment
- Level of evidence: weak
Unconstructive techniques
1) Rhetorical questions
2) Coercing (threats)
3) Coaxing (pleas)
4) Non-specific praise
5) Giving explanations
6) Reassurance
7) Punishment, belittling, humiliating
8) Denying/ignoring
Rhetorical questions
- Asking non-specific questions such as “would you like to get in the chair now?’
- Suggestion: use specific directive guidance; example: “Please sit in my chair.”
- Indications/contraindications: Should not be used with young children as they are more likely to interpret it as real question than social convention
Level of evidence: Fair
Coercing (threats)
- Finding fault with behavior angrily such as “If you don’t open, you won’t get to pick out a treasure.”
- Suggestion: Use directive guidance
- Indications/contraindications: Should not be used - may lead to noncooperation or resistance
- Level of evidence: fair
Coaxing (pleas)
- Trying to persuade or bribe the child such as “If you let me count your teeth, you can pick out a sticker.”
- Suggestion: use directive guidance, reward positive behavior after it is performed
- Indications/contraindications: should not be used scenario often ends with the child not completing task and still getting “rewarded” with bribe
- Level of evidence: Fair
Non-specific praise
- Ambiguous praising of child such as “You’re doing great!”
- Suggestion: use specific positive reinforcement such as “You are holding so still!”
- Indications/contraindications: specific reinforcement is more effective
- Level of evidence: fair
Giving explanations
- Demonstrating, orienting, explaining, and responding to questions concerning treatment or appointment beyond abbreviated Tell-Show-Do
- Suggestion: use short explanations and directives
- Indications/contraindications: effective in low stress/anxiety situations but ineffective in high stress situations; ineffective with very young children who cannot be rational
- Level of evidence: fair
Reassurance
- Making statements such as “Everything will be okay; don’t worry.”
- Suggestion: use empathetic questions and reflective listening
- Indications/contraindications: should not be used as statements do not really reassure
- Level of evidence: fair
Punishment, belittling, humiliating
- Making criticizing statements such as “You’re not being a big boy right now!”
- Suggestion: use other communicative guidance techniques that have been shown to improve behaviors
- Indications/contraindications: Should not be used
- Level of evidence: fair
Denying/ignoring
- Denying or ignoring statements of feelings or pain such as “That doesn’t hurt!”
- Suggestion: use empathetic questioning
- Indications/contraindications: should not be used
- Level of evidence: fair
Trend of pharmacological behavior management
Parental acceptance of pharmacological behavior management has increased over time.
