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Child psychology

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it is easier to build up a child than it is to repair an adult..!!

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Child psychology

  1. 1. SHAFEEQ RAHMAN
  2. 2. CONTENTS • INTRODUCTION • CLASSIFICATION OF PSHYCOLOGICAL DEVELOPMENT THEORIES • THE PSHYCOSEXUAL THEORY • PSYCHOSOCIAL THEORY • COGNITIVE THEORY • SOCIAL LEARNING THEORY • CLASSICAL CONDITIONING THEORY • PSYCOLOGICAL MANAGMENT OF ORTHODONTIC PATIENTS • CONCLUSION • REFERENCES
  3. 3. INTRODUCTION • Dentistry for children can be demanding, tumultuous, and frustrating; at the same time, it can be enriching, satisfying, and memorable. • Dentistry for children who display disruptive behaviors places unique demands on a dentist, requiring him or her to incorporate additional skills and knowledge.
  4. 4. “The child is father of the man”, and “As the twig is bent so grows the tree”
  5. 5. DEFINITIONS PSYCHOLOGY: • Study of human mind and its functions. It can be defined as ‘Science dealing with human nature, function and phenomenon of his soul in the main’. CHILD PSYCHOLOGY: • Science that deals with the mental power or an interaction between the conscious and subconscious element in a child. EMOTION: • Instinctive feeling as contrasted with reasoning - A feeling or mood manifesting into motor and glandular activity. BEHAVIOR: • Is any change observed in the functioning of the organism
  6. 6. IMPORTANCE OF STUDYING CHILD PSYCHOLOGY • provides a rich background of information about children’s behaviour and psychological growth under a variety of environmental conditions. • Provides understanding of basic psychological processes like learning, motivation, maturation, and socialization. • Stage wise understanding of a child helps to understand the characteristics of the adult. • To teach and motivate them about importance of primary and preventive care and the importance of oral health. McDonald. Dentistry for the child and adolescent :eighth edition
  7. 7. IMPORTANCE OF KNOWING CHILD PSYCHOLOGY IN DENTISTRY • To understand the child as he comes to dental office & know his problem in the way he explains. • To establish effective communication with child and parents, the basic skill is required. • Child and most importantly parents should develop confidence on our treatment and dentistry. • To teach and motivate them about importance of primary and preventive care and the importance of oral health. • The child and parent should be comfortable and treatment satisfactory to child, parent and the dentist. • To plan out effective treatment McDonald. Dentistry for the child and adolescent :eighth edition
  8. 8. Psychologists have found it convenient to identify the following chronological age groupings GERMINAL : First two weeks after conception. EMBRYO : Two to six weeks after conception FETUS :Six weeks after conception until birth NEONATE : First two weeks after birth INFANT : First two years of life PRESCHOOL CHILD : Two to six years of age. PRIMARY-SCHOOL CHILD : Six to nine years of age. INTERMEDIATE –SCHOOL CHILD : Nine to twelve years of age. JUNIOR HIGH SCHOOL CHILD : Twelve to fifteen years of age (the onset of adolescence occurs during this period).
  9. 9. Shakespeare found it poetically convenient to divide man’s life span into the following seven periods : 1. The infant 2. The school boy 3. Adolescent lover 4. The soldier or mature man, 5. The justice or middle aged man, 6. Old age and decline. Shakespeare’s monologue: 7. finally senility and second childhood.
  10. 10. Classification of psychological developmental theories PSYCHODYNAMIC THEORIES: • PSYCHOSEXUAL THEORY –SIGMUND FREUD • PSYCHOSOCIAL THEORY-ERIC ERICKSON • COGNITIVE THEORY- JEAN PIAGET BEHAVIORAL LEARNING THEORIES: • Social Learning Theory-Albert Bandura • Classical Conditioning Theory-Ivan Pavlov • Operant Conditioning Theory-Skinner McDonald. Dentistry for the child and adolescent :eighth edition
  11. 11. OTHER THEORIES • SEPARATION AND INDIVIDUALIZATION – MARGARET MAHLER. • ATTACHMENT THEORY – JOHN BOWLBY. • THEORY OF MORAL DEVELOPMENT – KOHLBERG L. • CHILDRENESE – HAIM GINOTT. McDonald. Dentistry for the child and adolescent :eighth edition
  12. 12. PSYCHOSEXUAL THEORY-DR. SIGMUND FREUD(1905)
  13. 13. • According to Freud, personality is mostly established by the age of five. • Early experiences play a large role in personality development and continue to influence behavior later in life. • Freud believed that personality develops through a series of childhood stages during which the pleasure seeking energies of the id become focused on certain erogenous areas. • These psychosexual energies, or libido, were described as the driving force behind behavior.
  14. 14. THE STRUCTURAL MODEL OF PERSONALITY • According to Freud’s psychoanalytic theory of personality, personality is composed of three elements. • These three elements of personality are known as the • ID • EGO • SUPEREGO • which work together to create complex human behaviors. McDonald. Dentistry for the child and adolescent :eighth edition
  15. 15. The Id • The id is the only component of personality that is present from birth • This aspect of personality is entirely unconscious and includes of the instinctive and primitive behaviors. • Id is the source of all psychic energy, making it the primary component of personality. • The id is driven by the pleasure principle, which strives for immediate gratification of all desires, and needs. • If these needs are not satisfied immediately, the result is a state anxiety or tension. McDonald. Dentistry for the child and adolescent :eighth edition
  16. 16. EGO: • The ego derives from the id and tends to maximize instinctual gratification while minimizing punishment and guile. • Famous quote: "Where the id ("it") was, there shall become ego ("I"). • SUPEREGO: • It is differentiated from the ego, and is partially unconscious. • Freud viewed the superego as the heir to the Oedipus complex: Children internalize parental values and standards around the age of 5 or 6 years McDonald. Dentistry for the child and adolescent :eighth edition
  17. 17. STAGES OF PSYCHOSEXUAL DEVELOPMENT • The Oral Stage (0 to 1 yr ) • The infant’s primary source of interaction occurs through the mouth, so the rooting and sucking reflex is especially important. • The mouth is vital for eating, and the infant derives pleasure from oral stimulation through gratifying activities such as tasting and sucking. McDonald. Dentistry for the child and adolescent :eighth edition
  18. 18. • Because the infant is entirely dependent upon caretakers, the infant also develops a sense of trust and comfort through this oral stimulation. • The primary conflict at this stage is the weaning process the child must become less dependent upon caretakers. McDonald. Dentistry for the child and adolescent :eighth edition
  19. 19.  The Anal Stage (2 to 3 yr) • The primary focus of the libido is on controlling bladder and bowel movements. • The major conflict at this stage is toilet training, the child has to learn to control his or her bodily needs. • Developing this control leads to a sense of accomplishment and independence. • Success at this stage is dependent upon the parents approach to toilet training. McDonald. Dentistry for the child and adolescent :eighth edition
  20. 20. • If parents take an approach that is too lenient, an anal- expulsive personality can develop in which the individual has a messy, wasteful, or destructive personality. • If parents are too strict or begin toilet training too early, an anal retentive personality develops in which the individual is stringent, orderly, rigid, and obsessive. McDonald. Dentistry for the child and adolescent :eighth edition
  21. 21. The Phallic Stage (3 to 7 yr) • The primary focus of the libido is on the genitals. • Children discover the differences between males and females. • Boys begin to view their fathers as a rival for the mother’s affections. • The Oedipus complex describes these feelings of wanting to possess the mother and the desire to replace the father. McDonald. Dentistry for the child and adolescent :eighth edition
  22. 22. • However, the child also fears that he will be punished by the father for these feelings, a fear Freud termed CASTRATION ANXIETY. • The term Electra complex has been used to described a similar set of feelings experienced by young girls. McDonald. Dentistry for the child and adolescent :eighth edition
  23. 23. The Latency stage (8 to 11 yr) • During the latent period, the libido interests are suppressed. • The development of the ego and superego contribute to this period of calm. • The stage begins around the time that children enter into school and become more concerned with peer relationships, hobbies, and other interests. • The latent period is a time of exploration in which the sexual energy is still present, but it is directed into other areas such as intellectual pursuits and social interactions. • This stage is important in the development of social and communication skills and self-confidence.
  24. 24. The Genital Stage (12 yrs to adult) • During the final stage of psychosexual development, the individual develops a strong sexual interest in the opposite sex. • Where in earlier stages the focus was solely on individual needs and, interest in the welfare of others grow during this stage. • If the other stages have been completed successfully, the individual should now be well balanced, warm, and caring. • The goal of this stage is to establish a balance between the various life areas. McDonald. Dentistry for the child and adolescent :eighth edition
  25. 25. Psychosocial Theory-Eric Erickson(1963) • Erikson is a Freudian ego-psychologist. • He accepts Freud's ideas as basically correct, including the more debatable ideas such as the Oedipal complex, and the ideas about the ego. • However, Erikson is much more society and culture-oriented than Freud
  26. 26. THE EPIGENETIC PRINCIPLE • This principle says that we develop through a predetermined unfolding of our personalities in eight stages. • Our progress through each stage is in part determined by our success, or lack of success, in all the previous stages. • Each stage involves certain developmental tasks. • The various tasks are referred to by two terms . • Each stage has a certain optimal time as well.
  27. 27. 1. Trust vs Mistrust 2. Autonomy vs. Shame and Doubt The child is developing physically and becoming more mobile The aim has to be “self control without a loss of self-esteem” (Gross, 1992.) Success in this stage will lead to the virtue of will. Erickson, E. (1958).Young man Luther:A study in psychoanalysis and history. NewYork: Norton
  28. 28. Erickson, E. (1958).Young man Luther:A study in psychoanalysis and history. NewYork: Norton
  29. 29. Occurring in young adulthood (ages 18 to 40 yrs).we begin to share ourselves more intimately with others. Success in this stage will lead to the virtue of love. 6.Intimacy vs. Isolation Bee, H. L. (1992).The developing child. London: HarperCollins
  30. 30. Involved in community activities and organization.this stage will lead to the virtue of care 7.GENERATIVEVS STAGNATION 8.Integrity vs. Despair Bee, H. L. (1992).The developing child. London: HarperCollins
  31. 31. Cognitive Theory-Jean Piaget (1952) • Piaget believed that every individual is born with the capacity to adjust and adapt to both physical and socio-cultaral environment in which he or she live in. • He described two processes used by the individual in its attempt to adapt: assimilation and accomodation. • Assimilation is the process of incorporation of events within environment into mental categories called cognitive structures or schemas. • Accomodation is the process of changing cognitive structures to better represent the environment.
  32. 32. • Both processes are used simultaneously and alternately throughout life. • As schemes become increasingly more complex (i.e., responsible for more complex behaviors) they are termed structures. • As one's structures become more complex, they are organized in a hierarchical manner (i.e., from general to specific). ProffitW R: ContemporaryOrthodontics. Mosby 2013.5th Edition
  33. 33. • Assimilation and accommodation work like a pendulum, swings at advancing our understanding of the world and our competency in it. • They both are directed to attain a balance between the structure of the mind and the environment, and that ideal state is called as equilibrium. • As Piaget continued his investigation of children, he noted that there were periods where assimilation dominated, periods where accommodation dominated, and periods of relative equilibrium, and that these periods were similar among all the children he looked at in their nature and their timing. • And so he developed the idea of stages of cognitive development. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  34. 34. The sensorimotor stage ( from birth to two years) • As the name implies, the infant uses senses and motor abilities to understand the world, beginning with reflexes and ending with complex combinations of sensorimotor skills • Between one and four months, the child works on primary circular reactions -- just an action of his own which serves as a stimulus to which it responds with the same action, and around and around. • Between four and 12 months, the infant turns to secondary circular reactions, which involve an act that extends out to the environment: She may squeeze a rubber duckie. It goes quack. • That is great, so do it again, and again. She is learning procedures that make interesting things last.
  35. 35. • Between 12 months and 24 months, the child works on tertiary circular reactions. • They consist of the same making interesting things last cycle, except with constant variation. • Around one and a half, the child is clearly developing mental representation, that is, the ability to hold an image in their mind for a period beyond the immediate experience Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  36. 36. Preoperational stage (two to about seven years). • Children begin to think symbolically and learn to use words and pictures to represent objects. • They also tend to be very egocentric, and see things only from their point of view. • Children at this stage tend to be egocentric and struggle to see things from the perspective of others. • Piaget did a study to investigate this phenomenon called the mountains study. • He would put children in front of a simple plaster mountain range and seat himself to the side, then ask them to pick from four pictures the view that he, Piaget, would see. Younger children would pick the picture of the view they themselves saw; older kids picked correctly.
  37. 37. • He is much more likely to understand: "Brushing makes your teeth feel clean and smooth” and, "Toothpaste makes your mouth taste good” because these statements rely on things the child can taste or feel immediately. • Another characteristic of thought process in this stage is Animism-investing inanimate objects with life. • For example while talking to a 4-year-old about how desirable it would be to stop thumb sucking . Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  38. 38. • The orthodontist might have only little problem in getting the child to accept the idea that "Mr. Thumb" was the problem and that the dentist and the child should form a partnership to control Mr. Thumb who wishes to get into the child's mouth. • Animism, in other words, can be applied even to parts of the child's own body, which seem to take on a life of their own in this view. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  39. 39. Concrete operations stage ( 7 to11 yrs). • The word operations refers to logical principles we use when solving problems. • In this stage, the child not only uses symbols representationally, but can manipulate those symbols logically. • But, at this point, they still perform these operations within the context of concrete situations. • The stage begins with progressive decentering. • By six or seven, most children develop the ability to conserve number, length, and liquid volume.
  40. 40. • Conservation refers to the idea that a quantity remains the same despite changes in appearance. • And he will know that you have to look at more than just the height of the milk in the glass: If we pour the milk from the short, fat glass into the tall, skinny glass, he will tell us that there is the same amount of milk as before, despite the dramatic increase in milk-level! .
  41. 41. • If we take a ball of clay and roll it into a long thin rod, or even split it into ten little pieces, the child knows that there is still the same amount of clay. • And he will know that, if we rolled it all back into a single ball, it would look quite the same as it did -- a feature known as reversibility. • By nine or ten, the last of the conservation tests is mastered- conservation of area. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  42. 42. • In addition, a child learns classification and seriation during this stage. Now the child begins to get the idea that one set can include another. • Seriation is putting things in order. The younger child may start putting things in order by, say size, but will quickly lose track. • Now the child has no problem with such a task. Since arithmetic is essentially nothing more than classification and seriation, the child is now ready for some formal education!
  43. 43. Formal operations stage (12 yrs to adult) • Around 12 yrs of age, child enter the formal operations stage. • Here he become increasingly competent at adult-style thinking. • This involves using logical operations, and using them in the abstract, rather than the concrete. We call this as hypothetical thinking. • Child is capable of understanding concepts like health ,disease ,preventive treatment etc. At this child should be treated like an adult. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  44. 44. CRITICISMS OF PSYCHODYNAMIC APPROACHES • Freud’s theories overemphasized the unconscious mind, aggression, and childhood experiences. • Many of the concepts proposed by psychodynamic theorists are difficult to measure and quantify. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  45. 45. • STRENGTHS OF PSYCHODYNAMIC APPROACHES • While most psychodynamic theories did not rely on experimental research, the methods and theories of psychodynamic thinking contributed to experimental psychology. • Many of the theories of personality developed by psychodynamic thinkers are still influential today, including Erikson’s theory of psychosocial stages and Freud’s psychosexual stage theory. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  46. 46. SOCIAL LEARNING THEORY-ALBERT BANDURA (1963) • He suggested that environment causes behavior, but behavior causes environment also. • He called this concept as reciprocal determinism. • The world and a persons behavior cause each other. • Development of personality takes place as an interaction among three things: the environment, behavior, and the persons psychological processes. • These psychological processes consist of our ability to entertain images in our minds, and language. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  47. 47. • According to Bandura the steps involved in the modeling are: • 1. ATTENTION: • If we are going to learn anything, we have to be pay attention. Likewise, anything that puts a damper on our attention is going to decrease learning, including observational learning. • Main thing that influence attention involves characteristics of the model. If the model is colorful and dramatic, we pay more attention. • If the model is attractive, or prestigious, or appears to be particularly competent, we will pay more attention. And if the model seems more like our self, we will pay more attention. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  48. 48. 2. RETENTION: • we must be able to retain what we have paid attention to. • This is where imagination and language come in. • We store what we have seen the model doing in the form of mental images or verbal descriptions. • When so stored, we can later bring up the image or description, so that we can reproduce it with our own behavior. 3.REPRODUCTION: • We have to translate the images or descriptions into actual behavior. • So we have to have the ability to reproduce the behavior in the first place. ProffitW R: ContemporaryOrthodontics. Mosby 2013.5th Edition
  49. 49. 4. MOTIVATION. • And yet, with all this, we are still not going to do anything unless we are not motivated to imitate, i.e. until we have some reason for doing it. Bandura mentioned following motives: a. past reinforcement. b. promised reinforcements - incentives. • Of course, the negative motivations are there as well, giving us reasons not to imitate someone: a. past punishment. b. promised punishment (threats). Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  50. 50. • Research has demonstrated that one of the best predictors of how anxious a child will be during dental treatment is how anxious the mother is. • A mother who is calm and relaxed about the prospect of dental treatment teaches the child by observation that this is the appropriate approach of being treated, whereas an anxious and alarmed mother tends to elicit the same set of responses in her child. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  51. 51. CLASSICAL CONDITIONING THEORY-IVAN PAVLOV (1927) • Described by the Russian physiologist Ivan Pavlov. • Who discovered during his studies of reflexes that apparently unassociated stimuli could produce reflexive behavior. • Pavlov's classic experiments involved the presentation of food to a hungry animal, along with ringing of a bell. • The sight and sound of food normally elicit salivation by a reflex mechanism. • If a bell is rung each time food is presented, the auditory stimulus of the ringing bell will become associated with the food presentation stimulus, and in a relatively short time, the ringing of a bell by itself will elicit salivation. • Classical conditioning, operates by the simple process of association of one stimulus with another, and some times also referred as learning by association. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  52. 52. • Classical conditioning can have a considerable impact on a young child's behavior on the first visit to a dental office. • By the time a child is brought for the first visit to a dentist, it is highly likely that he or she will have had many experiences with pediatricians and medical personnel. • When a child experiences pain, the reflex reaction is crying and withdrawal Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  53. 53. • In Pavlovian terms, the infliction of pain is an unconditioned stimulus, but a number of aspects of the setting in which the pain occurs can come to be associated with this unconditioned stimulus. • If the unconditioned stimulus of painful treatment comes to be associated with the conditioned stimulus of white coats, a child may cry and withdraw immediately at the first sight of a white coated dentist or dental assistant. • In this case, the child has learned to associate the unconditioned stimulus of pain and the conditioned stimulus of a white coated adult, and the mere sight of the white coat is enough to produce the reflex behavior initially associated with pain. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  54. 54. Operant Conditioning Theory-Skinner (1938) • The basic principle of operant conditioning is that the consequence of a behavior is in itself a stimulus that can affect future behavior. • In classical conditioning, a stimulus leads to a response; in operant conditioning, a response becomes a further stimuli. • The general rule is that if the consequence of a certain response is pleasant, that response is more like to be used again in the future; but if a particular respond produces an unpleasant consequence, the probability that response being used in the future is diminished. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  55. 55. • Skinner described four basic types of operant conditioning distinguished by the nature of the consequence . A) POSITIVE REINFORCEMENT:  If pleasant consequence follows a response, the response has been positively reinforced, and the behavior that led to the pleasant consequence becomes more likely in the future . B) NEGATIVE REINFORCEMENT:  involves the withdrawal of an unpleasant stimulus after a response. Like positive reinforcement, negative reinforcement also increases the likelihood of a response in the future. The word negative merely refers to the fact that the response that is reinforced is a response that leads to the removal of an undesirable stimulus. McDonald. Dentistry for the child and adolescent :eighth edition
  56. 56. C) OMISSION :  Involves removal of a pleasant stimulus after a particular response. For example, if a child who throws a temper tantrum, has his favorite toy taken away for a short time as a consequence of this behavior, the probability of similar misbehavior is decreased. D) PUNISHMENT:  Occurs when an unpleasant stimulus is presented after a response. This also decreases the probability of similar kind of behavior that prompted punishment in the future. Punishment is effective at all ages, not just with children.
  57. 57. • In general, positive and negative reinforcement are the most suitable types of operant conditioning for use in the dental office, particularly for motivating orthodontic patients. • Both types of reinforcement increase the likelihood of a particular behavior recurring, rather than attempting to suppress a behavior as punishment and omission do. Simply praising a child for desirable behavior produces positive reinforcement, and additional positive reinforcement can be achieved by presenting some tangible reward. McDonald. Dentistry for the child and adolescent :eighth edition
  58. 58. Psychological timing of orthodontic treatment-by-Jay Weiss:AJO-1977 • A questionnaire type of study was undertaken to test the hypothesis that prepubescent patients are more cooperative than adolescents. • Older children were found to be psychologically resistant to the demands of orthodontic treatment because of their involvement in Oedipal conflicts, a normal but distracting aspect of "growing up.“
  59. 59. • Study found that patients under 12 were more cooperative than other age groups in the wearing of headgear and other removable devices but they were less cooperative in keeping appointments or in protecting appliances from breakage. • The study suggests that, from a psychological standpoint, activator and headgear treatment should be begun sometime after age 6 and soon enough to be completed before the onset of puberty.
  60. 60. • Children at this stage still are not likely to be motivated by abstract concepts such as "If you wear this appliance your bite will be better." They can be motivated, however, by improved acceptance or status from the peer group. • This means that emphasizing how the teeth will look better as the child cooperates is more likely to be a motivating factor than emphasizing a better dental occlusion, which the peer group is not likely to notice.
  61. 61. • Most orthodontic treatment is carried out during the adolescent years, and behavioral management of adolescents can be extremely challenging. • Since parental authority is being rejected, a poor psychological situation is created by orthodontic treatment if it is being carried out primarily because the parents want it, not the child. • At this stage, orthodontic treatment should be instituted only if the patient wants it, not just to please the parents.
  62. 62. Psychological Management of Orthodontic Patient : Louis Norton- AO July 1971 YOUNG CHILD (6 TO 9 YRS): • Easiest to work with. • Same approach for both boys and girls. • Natural curiosity of school days makes their attention readily available. • The best method for obtaining cooperation is to actively teach the child the purpose of your treatment. • Careful explain about what you intend to do and a brief why, using language that the child can understand. • This may be supplemented with charts, simple stories which the child can read himself or short single concept films.
  63. 63. • Children of this age are natural imitators. • They tend to do almost anything they are told to do, particularly if it is with precise directions. • This is why most children of this age respond well to tooth brushing charts and tables which allow them to see how well they are progressing. This, in effect, is a simplified teaching machine. • Praise should be given freely as a means of re-enforcement. • The bribe of a toy for good behavior from the dentist decreases their desire to know what is happening to them. Bribery should therefore not be used. Psychological Management of Orthodontic Patient : Louis Norton- AO July 1971
  64. 64. • It is difficult to use removable appliances in children from six to nine. • In the early mixed dentition when undercut areas for appliance retention are hard to find. • They are learning to articulate adult speech patterns. • They are attempting to break their infantile habits of digital sucking and tongue thrusting. Psychological Management of Orthodontic Patient : Louis Norton- AO July 1971
  65. 65. Early Adolescent (ten to thirteen yrs) • BOYS: • Retains his curiosity about the "why" of treatment during this period, but the "how" begins to capture his imagination. • He is fascinated by scientific instruments and mechanical gadgets. • He is also looking for a hero, to emulate. • It is not unusual for a personable dentist to fill this hero's role for the child. • To gain cooperation from a boy of this age group, one must show interest in his interests. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  66. 66. • One must again be careful to explain each procedure to the child and why. • "Show and tell" explanations will lead him to ask "how do you do that, or how does this machine work?". • Let him observe operative procedures through a hand mirror. • Allow him to hold some materials such as periphery wax, alginate or blunt hand instruments. • If he seemed quite excited by this, the reward of a trip to the laboratory will turn the young patient into a fast friend. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  67. 67.  FEMALE : • Quite different from the boy but an equal challenge. • She is passionately interested in her developing body. • Any dental procedure that might affect her looks is either accepted with exuberance or dread. • She is very susceptible to flattery which can lead to the ''crush syndrome" which can be a management problem. • Efforts to establish rapport through conversation can end up as a talked away appointment. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  68. 68. • Friendliness may be demonstrated by a smile and a compliment on behavior or an achievement. • References to her body, may invite problems. For example if you say she has gotten quite tall. • The conversation should be brief, pleasant, impersonal and thoughtful. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  69. 69. The Teenage (14 to 18 yrs) MALE: • Express the adult image which is usually overtly uncomfortable for him. • He wishes to be treated as an adult but often express himself as an irrational child. • His interests have now narrowed to normal development of his body, acceptance by his peers. • He spends hours primping himself in the mirror. • He is desperately fighting anything that makes him look different from the group with whom he identifies. • Management of the teenage male is a matter of sympathy and understanding. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  70. 70. • One must be direct and forthright. Being devious or overly complex will lead to suspicion. • Trust is the most valuable asset to be sought from this age group. • It is important that treatment plans be discussed with the same logic, responsibility and firmness, as with an adult patient. • This allows the boy to assume the adult role which will soon be reality. • If discipline becomes a problem the dentist has an advantage. • He is an authority figure outside the family. • The chances are good that a boy will readily discuss why he is not following your instructions. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  71. 71.  Female • She is conscious about her appearance and peers. • She wants to be as proportional as her peers. • Orthodontic appliances offer a threat to her immediate body image or, if she has an unaesthetic malocclusion, they offer a promise. • The thrust in management must be toward the cosmetic and status value. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  72. 72. • Once trust is established, she will usually be cooperative , probably due to her earlier maturity. • Discipline should again be handled by discussing the root of the problem and its various solutions rather than making “parent like” demands for cooperation. • Latent crush syndromes can occur in this age group, particularly in girl with the unaesthetic malocclusion. • The orthodontist is freeing her of her problem. He takes on the proportions of a hero. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  73. 73. • They are trying to assume the role of an adult and they do not believe their parents have an understanding of any of their problems. • Therefore detailed consultations and progress reports should be given to the parent and child, but separately. • The patient will take comfort in knowing that his parents are concerned about his treatment, but the patient will take offense if she feels they are directing it. • The primary relationship is with the child and not with the parents. Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition
  74. 74. PRACTICAL PSYCHOLOGY TO THE CLINICAL PRACTICE OF ORTHODONTICS  DIVIDED INTO TWO BROAD CATEGORIES: 1.SOCIAL PSYCHOLOGY OF ORTHODONTICS. 2.ORTHODONTIC MOTIVATIONAL PSYCHOLOGY. • A RELATIVELY NEW AREA OF APPLICATION 3. EDUCATIONAL PSYCHOLOGY. Methods of improving patient compliance • JCO 1996 Sep MELVIN MAYERSON, R.G “WICK” ALEXANDER
  75. 75. SOCIAL PSYCHOLOGY • Why patient’s seek orthodontic treatment ? • Adolescents : my mom thinks I need braces, to look better • Adults : own initiative; to improve facial appearance. • Clearly a person’s dentofacial appearance can have a significant effect at their overall quality of life. Methods of improving patient compliance • JCO 1996 Sep MELVIN MAYERSON, R.G “WICK”ALEXANDER
  76. 76. Methods of improving patient compliance A.O. 1998 No. 2, T. Mehra, R.S. Nanda, P.K Sinha. (1) verbally praising the patient, (2) educating the patient about the consequences of poor compliance, (3) discussing treatment goals with the patient, (4) educating the patient about the proper use of elastics, (5) educating the parent about the consequence of poor compliance, (6) discussing poor patient cooperation with the patient, (7) educating the patient about the proper use of headgear, (8) discussing poor patient cooperation with the parent, (9) discussing treatment goals with the parent, and (10) educating the parent about the use of orthodontic appliances.
  77. 77. CONCLUSION • One golden thread that runs through out the literature of orthodontic psychology is the importance of the doctor-patient relationship. Once the orthodontist has earned the trust and respect of the patient by establishing a good rapport , the task of achieving a good treatment result is made remarkably easier
  78. 78. REFERENCES • Proffit W R: Contemporary Orthodontics. Mosby 2013.5th Edition • McDonald. Dentistry for the child and adolescent • Moyers Robert E.: Hand book of Orthodontics • Angle Orthod. 1998 Apr;68(2):115-22. Orthodontists' assessment and management of patient compliance.Mehra , Nanda RS, Sinha PK. • Methods of improving patient compliance • JCO 1996 Sep MELVIN MAYERSON, R.G “WICK” ALEXANDER • Psychological Management of Orthodontic Patient : Louis Norton- AO July 1971 • Erickson, E. (1958). Young man Luther: A study in psychoanalysis and history. New York: Norton. • Gross, R. D., & Humphreys, P. (1992). Psychology: The science of mind and behaviour. London: Hodder & Stoughton. Freud, S. (1923). The ego and the id. SE, 19: 1-66. • Piaget's Stages of Cognitive Development Kay C. Wood, Harlan Smith, Daurice Grossniklaus Department of Educational Psychology and Instructional Technology, University of Georgia
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it is easier to build up a child than it is to repair an adult..!!

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