social and behavioral development

Question 1

Classical Conditioning

Answer 1

• Classical conditioning occurs readily in children
• White coat syndrome

Take home:
• Make the office look and feel as little like a pediatrician’s office or hospital as possible – develop discrimination
• Make the first visit/visits “happy visits” especially if there has already been a negative experience. (May need to convince parents to make multiple appointments)

Question 2

Operant Conditioning

Answer 2

• Extension of Classical conditioning
• Consequence of a behavior is itself a stimulus that can influence future behavior.
• Reinforcement increases likelihood of behavior.
• Punishment decrease likelihood of behavior

Question 3

Positive Reinforcement

Answer 3

• Desired behavior is rewarded (likelihood of behavior increased)
• Toy given to a child for good behavior.
• Giving praise or compliment for good behavior
• Noticing and complimenting improved hygiene.

Question 4

Negative reinforcement

Answer 4

• Unpleasant stimulus is removed as result of behavior (likelihood of
behavior increased).
• Can go two ways.
1. Tantrum gets you out of the situation- throw a bigger one next
time.
2. Appointment time shortened due to good behavior.
a. May need to help patient recognize the association.

Question 5

Negative punishment (omission/timeout)

Answer 5

• Something is taken away as a result of the behavior
• Toy is taken away after a tantrum.
• The punishment is the removal of a pleasant stimulus.

Question 6

Positive Punishment

Answer 6

• Behavior results in an unpleasant stimulus being presented.
• Speeding ticket

Question 7

Operant conditioning in the dental office

Answer 7

• Positive and negative reinforcement are most appropriate for the dental office.
• Be careful to not inadvertently use negative reinforcement of unwanted behavior.
• Punishments should be used with caution.
• Voice control may sometimes be used but must be followed by positive reinforcement when behavior improves.
• Careful not to introduce fear- (classical conditioning creating association between the dental office and fear).

Question 8

Observational Learning

Answer 8

• Acquisition of behavior by imitation.
• 2 stages: Acquisition and Performance
• Behavior moves from acquisition to performance if the model is liked/respected/trusted.
• Take home: Let younger siblings see older siblings behaving and being rewarded
• Open treatment areas.

Question 9

Emotional Development:

Answer 9

8 stages of man

Associated with chronological age but more important and constant is the sequence.

Question 10

Development of basic trust (mistrust)

Answer 10

0-18 months
• Basic trust or lack of trust is developed.
• Child is usually very attached to parent at this stage.
• If patient hasn’t developed basic trust, they may be fearful and uncooperative.

Take home:
• Best to treat patient with parent, knee to knee is a good option.
• Be patient with children. Try to find clues about parental relationship.

Question 11

Autonomy (or shame)

Answer 11

18 months to 3 years old, step 2
• Terrible Twos
• Child is finding independence and ability to choose.

• If it’s not their idea, it likely won’t happen.
• Take home: Give choices
• Still good to have parent present
• Complex treatment best done under sedation of general anesthesia.

Question 12

: Development of Initiative (or Guilt)

Answer 12

STEP 3
3-6 years old
• Physical activity and motion
• Tons of questions, very curious.
• Important to succeed- perceived failure is detrimental.
• Take home:
• First dental visit is usually in this period of development
• A successful visit will produce a sense of accomplishment for the patient.
• Consider an exploratory visit with little treatment done.
• Usually better to treat away from parent to reinforce independence.

Question 13

Industry/mastery of skills (or inferiority)

Answer 13

step 4
7-11 years old
• Acquiring academic and social skills which allow them to compete in an environment where those who produce are recognized.
• Necessity of working together is realized
• Peers becoming more important.
• Realistic goals should be set and met.
Take home:
• Compliance depend on child understanding what is needed to please parents, dentist and peers.
• Not motivated by abstract things like “a better bite.”

Question 14

Development of Identity (or Role confusion)

Answer 14

step 5
12 -17 years old
• Adolescence
• Realizing one can exist outside the family
• Rejecting parental authority, peer group extremely important.
• Motivation is internal or external
• Internal- Desire to improve appearance- sometimes as a result of bullying.
• External- “to get mom off my back.”
• Take home
• It is very important that a patient in this age group has an internal desire to undergo any
prolonged or involved treatment such as orthodontic treatment.
• Teenage boy with grandma vs Teenage girl with anterior crossbite.

Question 15

Development of Intimacy ( or Isolation)

Answer 15

step 6
Young Adult
• Creating close meaningful relationships.
• Ability to sacrifice and compromise for a relationship.

• Take home:
• Some seek esthetic treatment for improved chance at relationships.
• Drastic changes in appearance (new look) can possibly interfere with existing relationship as the partner may view the change as altering the relationship.

Question 16

Cognitive Development

Answer 16

Development of intellectual capabilities.
• Via assimilation and accommodation.
• Related to age.

Question 17

assimilation and accommodation

Answer 17

Assimilation :
Incorporating events within the environment into mental categories.
• Child sees something fly ->learns it’s a bird-> everything that flies is a bird

• Accommodation:
Child changes mental categories to better represent the environment
• Learning to distinguish a bird from a fly

• Intelligence develops as assimilation and accommodation build on one another.

Question 18

Sensorimotor development

Answer 18

0-2 years old
• Discover reality of objects- they don’t disappear when not being looked at.
• Limited ability to project forward or backward.
• Usually aren’t treating patients in this age group but can have patients with disabilities that could fall into any stage of development.

Question 19

Preoperational Period

Answer 19

2-7 years old
• They use words like adults, they appear to think more like adults than they really do.
• Limited association- My daughter will say “I’m not pretty, I’m Maddisyn.”
• Understand the world through 5 senses.
• If its not touched, tasted, seen, heard, or smelled, it’s hard to understand
• Incapable of seeing another person’s point of view (egocentrism).
• Apply life to inanimate objects (Animism).

• Take home:
• Talk to 4-year-old about Mr. Thumb being a problem when he wants to get into the mouth.
• Focus on senses: Brushing makes your teeth feel clean and smooth and makes your mouth
taste good.

Question 20

Period of Concrete Operations

Answer 20

7-11 years old
• Develops ability to see another’s point of view
• Limited but increasing ability to think about abstract things.

• Take home:
• Present concrete directions.

Question 21

Period of Formal Operations-

Answer 21

11 years old to adulthood
• Can think about thinking.
• Adolescents think that others are thinking about them (imaginary audience.”
• Self conscious because “others are thinking about what I’m wearing, doing, etc.
• Adolescents see themselves as unique leading to the “ personal fable.”
• Personal fable- I’m unique. Everyone cares about what I’m doing. Nothing bad will
happen me…
In working with teenagers don’t try to change their reality of the imaginary audience and
personal fable. Rather help them better see reality.

• Take home:
• Provide guidance toward a more accurate evaluation of the attitude of the audience. Not by telling
them, but rather giving them a chance to see for themselves.