Psychosocial Development

Question 1

What are the basic mechanisms of learning in young children?

Answer 1

3 distinct mechanisms involved:

Classic conditioning

Operant conditioning

Observational learning

Question 2

What is classical conditioning?

Answer 2

The simple process of associating 1 stimulus with another. This is known as learning by association.

Question 3

How does classic conditioning apply to dental practice?

Answer 3

Children can associate pain with many aspects of the dental practice and this can cause unfavourable reactions of child patients to the stimulus.

Due to association between dental and medical office. Behavioural management of dental office is easier if the 2 experiences of the child are unconditioned by making the dental office look more child friendly.

Question 4

What is reinforcement?

Answer 4

Association between a conditioned and an unconditioned stimulus is reinforced every time they occur together.

Every time a child has something unpleasant happen when taken to a typical doctor’s office the child becomes more and more sure bad things will happen at such a place.

Question 5

What are the 2 stages of observational learning?

Answer 5

Acquisition of the behaviour by observing it

Performance of the behaviour

Question 6

What are the characteristics of someone that is imitated by a child that is learning through observational learning?

Answer 6

The role model is often liked or respected and the behaviour is rewarded rather than punishment.

Question 7

How can the principles of observational learning be applied to the dental practice?

Answer 7

A calm parent when her child visits the dental clinic will ensure that the child is also calm.

Question 8

What occurs during the first stage of early emotional development?

Answer 8

Development of basic trust. This is developed by a caring mother or mother substitute who meets the emotional needs of the infant. For this, a strong bond between the parent and the child must be maintained.

Question 9

What is erickson’s theory of development?

Answer 9

There are 8 stages of psychosocial development in which the individual is forced towards one side or the other outcome of that stage, These stages occur at different stages at different times for different individuals.

Question 10

How does Erickson’s first stage of development apply to dental practice?

Answer 10

This is reflected in separation anxiety seen when child is separated from the parent. During this stage it is preferable if the mother is present next to the child during the development of the child. 0 - 18 months

Question 11

What happens in Erickson’s 2nd stage of development?

Answer 11

The child develops his/her sense of autonomy. 18 months - 3 years.

During this stage the child needs to be protected from the consequences of dangerous and unacceptable behaviour while also given opportunities to develop independent behaviour.

Question 12

What happens during Erickson’s third stage of development?

Answer 12

The child develops initiative. In this stage, further autonomy is developed accompanied by extreme curiosity and questioning. At this stage, the child is very teachable and eagerly models behaviour by those he respects.

The child’s ultimate abilty to initiate new ideas or activities is thought to depend on this stage to express new thoughts without being made to feel guilty about it.

Question 13

How does cognitive development take place?

Answer 13

In 4 stages:

Sensorimotor period

Preoperational period

Period of concrete operations

Period of formal operations

Question 14

What happens during the sensorimotor period?

Answer 14

The child develops the concept of objects as being things that are permanent rather than disappearing when the child is not looking at them. The foundation for language is laid but communication with adults is limited.

This is in the period from birth to 2 years.

Question 15

What happens during the preoperational period?

Answer 15

The child develops the capacity to form mental symbols representing things and events that are not present and learns to use words and symbolize these absent objects.

At this stage a child understands words quite differently from adults.

Child understands things in the way he/she experiences it.

Egocentrism makes a child find difficulty in considering another person’s perspective.

Animism. Child invests inanimate objects with life.

Question 16

How should communication with preschool children in dental treatment setting?

Answer 16

It is unusual for dentists to work with infants, but if this is necessary, remember the importance of separation anxiety in this age group:

having the mother (or father if he is the primary caregiver) present is important, and it is advantageous to have the parent holding the child
the parent’s attitude is important—if she or he is calm, the infant likely also will be, and if the parent is anxious and upset, the infant will pick up on that as well.

Question 17

How do you deal with a 2- or 3-year old child who is likely to reject almost any suggestion and is determined to have things his own way?

Answer 17

Separation anxiety still must be considered, and having the mother present can be helpful. In addition, it is very helpful to arrange things so that the child has choices and is led to think that he or she chose to do whatever is required rather than being forced to do it. Offering choices to the child—would you like to ride up in this chair, or would you rather jump up there after it goes up? would you like a green napkin or a yellow one?—can help in dealing with this search for autonomy.

Question 18

How are 4 - 6 year olds likely to be in the practice?

Answer 18

In the age 4-6 group, a child is likely to be intensely curious about the dentist’s office and what goes on there. An exploratory visit with the mother present and little or no treatment usually helps the dentist get off to a good start. After that, the child’s degree of independence must be considered. A child at this stage usually tolerates being separated from the mother and may behave better if she is not present, so that independence rather than dependence is reinforced—but with some children at this age, having the mother present can be helpful, and it’s OK to ask for her help

Question 19

How should a 4 to 6 year old be approached with learning?

Answer 19

Intellectually, a 4- to 6-year old preschool child uses language in a very literal sense and understands words only in the context in which they were learned. He or she is not able to comprehend complex language or concepts that are outside direct experience with the world. Nor can such a child assume another’s point of view.

For this reason, the dentist and dental staff should use immediate sensations instead of abstract reasoning in discussing concepts like prevention of dental disease. The child can understand and relate to “Brushing your teeth makes them feel clean and smooth”, but not to “Brushing your teeth will prevent tooth decay”. It does no good to tell the child how proud the parents will be if he brushes his teeth well. Assuming the parents’ point of view and imagining how they will feel is beyond the mental capacity of a child of this age. Egocentrism, focusing on your own point of view, is a characteristic of this age group.

Animism, another major characteristic at this age, can be used to the dentists’ advantage in communicating with the child. The dental handpiece is friendlier if it becomes “Whistling Willie” rather than a cutting instrument, and other dental instruments are more acceptable if named similarly. As we have noted already, if Mr. Thumb is a problem because he gets into the child’s mouth, it’s better for the dentist and the child to form a partnership to keep Mr. Thumb out rather than telling the child to stop sucking his thumb.

Observational learning

Question 20

What are the types of operant conditioning?

Answer 20

Positive reinforcement

Negative reinforcement

Omission (removal of pleasant stimulus after undesired response)

Punishment (unpleasant stimulus follows undesirable behaviour)

Question 21

What happens during erickson’s 4th stage of emotional development?

Answer 21

Mastery of skills; the influence of peer group at this stage starts to matter more than parental influence.

Question 22

Can children at ages 7 - 11 understand abstract concepts well?

Answer 22

No, for this reason they should be told more specifically what to do.

Question 23

How should elementary school aged children be communicated with?

Answer 23

School aged children’s psychosocial development is heavily influenced by operant conditioning.

Because observational learning is so important, it is more effective to put children in an open treatment area where they have an opportunity to see what is happening with their peers, rather than using small private treatment rooms.

Instructions on what the child should do between appointments must be presented concretely and simply, in a “show and tell” format.

In orthodontics, the same approach of concrete instructions is needed with children in the earlier elementary school years, but could be modified somewhat with those beyond age 11. The objective, of course, is to be sure the child (and parent) understand how the appliance is to be used, and what the goal of treatment is.

Question 24

What stage of erickson’s emotional development stages is seen during adolescence?

Answer 24

Development of personal identity. During this time, physical ability and academic responsibilities increase, and career possibilities begin to be defined.

Question 25

What happens during adolescence to cognitive development?

Answer 25

The period of formal operations.

At this stage the child’s thought processes have become similar to adults, and he or she should be treated as an adult. The child now can deal with abstractions and complex reasoning, and is aware that others also think in the same way—but in a new expression of egocentrism, each adolescent presumes that others are thinking about the same things he or she is, himself or herself.

Question 26

What is the personal fable?

Answer 26

During adolescence, a child develops a story about who they are in the world and that they are unique and special.

Question 27

What happens during stage 6 of erickson’s emotional development?

Answer 27

The development of intimacy in young adults. This results in the affiliations and partnetships with both opposite sex and others of the same sex to allow progress towards achieving career goals.

Question 28

What are the final stages of emotional development?

Answer 28

Guidance of the next generation in which the contrasts are generativity vs stagnation

Attainment of integrity in which the contrasts are integrity vs despair.