Vous êtes sur la page 1sur 54


Psychodynamic Theories
Behavior Learning Theories

Introduction:The study of the human personality and behavior

is one of the most interesting branches of science.
With the developing personality comes the
acquisition of the newer skills the power to think
and reason, various emotions like fear, anxiety,
joy, happiness etc. each of these contributing in its
own way to convert the infant into a mature adult.
With age the infant acquires certain skills these are the
basic of the human being. Recognition of face,
locomotion, speech, motor activity etc. each of these skills
is acquired at a specific age. These skills are termed as
developmental milestones, which act as indicators of child


It can be defined as the branch of the science

dealing with the human and animal behavior and
related mental processes.
A pediatric dentist, in order to carry out the
treatment of a child should have an accurate picture
of the developmental pattern of the child.

Child Psychology:It is the science or study of the childs mind and how it
functions. It is also the science that deals with the mental
power or an interaction between the conscious and
subconscious elements in a child.

Emotion:An effective state of consciousness in which joy,

sorrow, fear hate, or the likes are expressed.
A feeling or mood manifesting in motor or glandular

Behavior:It is any change observed in the functioning of the


Behavior Management:The means by which the dental health team effectively and
efficiently performs treatment for a child and simultaneously

instills a positive dental attitude in the child.

To understand the pattern of child development

various theories have been put forward.

Classification of Theories of
Development:The theories are broadly classified as:(a)Psychodynamic Theories
(b) Behavior Learning Theories

(A)Psychodynamic theories :Classical Psychoanalytical theory by Sigmund Freud

Psychosocial Developmental task theory by Erik
Hierarchy of needs by Abraham Maslow(1954)

Behavior learning theories :Classical conditioning theory by Ivan Pavlov.(1927)

Operant conditioning theory by
B.F Skinner.(1938)
Social learning theory by
Albert Bandura.(1963)
Theory of cognitive Development by Jean Piaget.

Psychodynamic theories:Classical Psychoanalytical theory:The first formal theory of personality to have marked
impact on psychology and psychiatry was that of
Sigmund Freud given in the year 1905. This concept
of personality was based on the interaction between
three systems within each individual. He called these
systems as the Id, the Ego and the Super Ego.

The Id:It is the source of all gratification and pleasure. It represents

the unconscious, instinctive urges that motivate behavior.
The id operates on what Freud described as the pleasure
principle. But the inner urges of the id can find satisfaction
only in external sources.

Hence Id can be defined as, the inherited reservoir

of unorganized drives.
It mostly unconscious, is governed by the pleasurepain principle, aims at immediate satisfaction of
libidinal urges, is immoral, is illogical, and lacks unity
of purpose.

The Ego:It is the ego that makes the necessary interaction

with the social world possible and permits the needs
of the id to be satisfied. Although the ego serves as a
way of satisfying id impulses, it responds to the
reality principle. If the id were left entirely to its own
devices, the organism would probably be destroyed.
Thus the ego serves to control the Ids pleasure
Hence, the ego can be defined as the integrating or
mediating part of personality, which develops out of
interaction of Id and environment. It has perception
both of the internal and of the external world.

The Superego:It acts as a conscience it is the internal part of the

individual that makes the value judgments.
The superego is idealistic; it is not necessarily
composed of societys standard unless the individual
has accepted and internalized them.
The child is born without a superego.
This element of personality structure is developed
under the training and influence of the environment.
It can be defined as the latest development of the mind
embodying the code of the society and including

the ideals.
Freud postulated several major stages of
development, each involving special adjustment
problems and each contributing to childs behavior.

Oral Stage(Birth-18 months):This stage is characterized by the infants concern

for his mouth and the gratification he feels from oral
Eating is the most obvious activity from which the
child derives the maximum pleasure .
Oral stimulation is also produced by engaging in activities
such as sucking, biting, swallowing and manipulating various
parts of the mouth.

Freud contended that these activities are the childs

means of fulfilling his sexual urges.
During this age the childs personality is controlled
by the id. He demands immediate gratification of his

Oral Stage

(II) Anal stage(18 months -3 years)

In this stage the bowel movements becomes the
source of the pleasure to the child.
He may defecate often to achieve this pleasure.
This however, would bring him in conflict with his
parents. The conflict leads the child to develop an
He comes to realize that he cannot always do what
he wants, when he wants.
He learns that there are certain times when it is
appropriate to expel waste and other time it is

He gradually comes to understand his mother

wishes and abides by them.

(III) Phallic Stage(3-7 years):In this stage the childs central interest shifts to the
genital region.
Sexual gratification becomes more erotic during this
Each stage has certain difficult tasks associated
with it where problems are more likely to arise. For
the phallic stage they are:-

Oedipal complex:The first object of love for all of us is our mother.

The young boy however has a rival for his mothers
love; his father.

He also recognizes the difference between boys and

girls that he has a penis and girls do not.

(ii) Electra complex:-

The girl child develops affection towards her father

and sees the mother as her main rival.
The girl child also recognizes difference between
boy and girl and therefore suffers from penis envy.
This is called Electra complex.

(IV) Latent stage(7-11 years):Freud believed that sexual impulses are suppressed
in the service of learning. This is a relatively dormant
stage from the view of psychological development.

(V)Genital stage(11-18 years):It is the longest of the five stages.

This period is similar to the anal stage. This is a
renewed interest and pleasure derived from excretory
This represents the resurgence of sex drive in
adolescence and the more specific focusing of
pleasure in sexual intercourse.

In the beginning, the person seeks association with

the members of his own sex but associations are
stronger in genital phase.
As the period progresses, the child makes contact
and forms relationship with members of the opposite
Also, at this time the superego undergoes further
development and becomes more flexible.

Shortcomings of Freuds theory:-

Too much emphasis has been placed on the role of

the sexuality in psychological development.
Role of society in development of behavior has been
totally neglected.

Psychosocial theory:Erik Erikson, a friend and student of Freud,

elaborated and modified Freuds theory in 1963 by
superimposition of psychosocial and psychosocial
Eriksons theory postulates that the society
responds to the childs basic needs or developmental
tasks in each specific period of life.
His approach emphasizes the dependent interaction
of the individual and the society.

Eriksons eight stages of development:-


At each stages of development a child faces various

developmental tasks and contradictory themes.
If the child resolves the conflict successfully it
results in positive outcome, if not it results in
negative outcome.

Trust vs. Mistrust(0-1 years):Description:-

The infant is helpless and seeks the same comfort

and security as that of mothers womb.
Infants depend on others to meet their basic needs,
and therefore blindly trust the caregivers to provide

If their needs are met consistently and responsively,

infants will learn to trust their environment and the
people in it.
Negative outcome:-

If their needs are not responsively met, infants may

view the world with mistrust.

(ii) Autonomy vs. shame:Description:

Toddlers learn to explore and do things for

themselves. Their self control and self-confidence
begin to develop at this stage.

If the child is encouraged to explore and reassured

when mistakes are made, the child will develop a
sense of autonomy and confidence needed to cope
with future situations.
Negative outcome:-

If parents are overprotective or extremely critical,

the child may be ashamed of his behavior and doubt
his/her abilities.


Children begin to interact with the environment, the

motor and language skills begin to develop. They
display an eagerness for adventure and play and
learn to control impulsive behavior.

If parents are encouraging and at the same time

consistent in disciplining the child, he/she will learn
to accept the concept of right and wrong and not feel
ashamed in using his imagination.
Negative outcome:-

If the childs initiatives are constantly curtailed by

the caregiver, he may develop a sense of guilt and
may come to believe that it is wrong to be

(iv) Industry vs. inferiority(6-12 years)


School is the important event at this stage. Child

learns to master basic social and academic skills.
Peers become the key social agent at this stage.
Positive outcome:-

If the children can find pleasure in learning, being

productive, and seeking success, they will develop a
sense of industry and competence
Negative outcome:-

If a child is unable to do so, he/she will develop

feelings of inferiority that will be exhibited later in life
as an inability to take up responsibility.

(v) Self identity vs. Role confusion:Description:-

This is the crossroad between childhood and

maturity when adolescents begin to ask Who am I?
The key social agent is the persons society of peers.
Positive outcome:-

Adolescents who solve this conflict successfully will

develop a strong identity and will be ready to plan
the future.
Negative outcome:-

If not the adolescent will sink into confusion and will

be unable to make decisions and choices about
his/her role in life.

The next three stages in Eriksons developmental

theory are concerned with the development in
adulthood. This period starts at about eighteen to
twenty and extends into old age.
According to Erikson,
(i) An individual who is around 20 years of age begins
to be concerned with the theme of intimacy which
generally results in marriage or long lasting sexual
(ii)In next stage the individual become concerned
with being generative to improve themselves and the
society in which they live.
iii)Finally the last stage is concerned with the concept of ego
integrity versus despair. If one successfully resolves all the
crises or conflicts in life, then that individual looks back and
develops a sense of ego and satisfaction. . On the other
hand, if resolutions were unsuccessful in one or more stages
of development, then a feeling of despair or incompetence

Behaviour Learning Theories:Classical conditioning theory:This theory was given by Ivan Pavlov in 1927.
According to this theory a child learns to associate two
events that occur simultaneously and develops conditioned
response eg. A child associates dental hand piece with pain
and hence the mere sight or sound of handpiece can evoke

Classical conditioning
Pavlovs famous experiment with a dog.

The principles involved in this process:Acquisition:- learning a new response from the
environment by conditioning.
Generalization:- wherein the process of conditioning
is evoked a band of stimuli centered around a specific
conditioned stimulus. Thus a test stimulus similar to
training stimulus results in a response. e.g. a child
who has had a painful experience with the doctor in
white coat will always associates any doctor in white
coat with the pain.
Extinction:- of the conditioned behavior results if the
association between the conditioned and the unconditioned

mentioned example subsequent visits to the doctor

without any unpleasant experiences results in
extinction of the fear.
Discrimination:- is opposite of generalization. If the
child is exposed to clinic settings which are different
to those associated with the painful experiences the
child learns to discriminate between the two clinics
and even the generalized response to any office will
be extinguished.

This theory was put forward by B.F. Skinner in 1938.

According to this theory the consequence of
behavior itself acts as a stimulus and affects future
Behavior that operates or control the environment is
called operant.
It stresses that reinforcement is the critical factor for
learning and therefore for development of
Skinner described four basic types of operant
conditioning by the type of consequences:-

Positive reinforcement:It occurs if a pleasant consequence follows the

response e.g a child rewarded for good behavior
following dental treatment.

Negative reinforcement:It involves removal of unpleasant stimuli following a

response e.g if the parent gives into the tamper
tantrums thrown by a child, he reinforces this

Omission:Refers to removal of the pleasant response after a

particular response e.g if the child misbehaves during
the dental procedure, his favorite toy is taken away
for a short time resulting in the omission of the
undesirable behavior.

Punishment:It involves introduction of an aversive stimulus into a

situation to decrease the undesirable behavior. Eg:
use of palatal rake in correction of tongue thrusting

Social Learning theory:This theory was proposed by

Albert Bandura in 1963.
According to this theory behavior is motivated by &
social needs. An important concept of this theory is
modeling which is imitation through observational
Reinforcements are considered as adjuncts and not
a necessity for behavior learning.

Jean Piaget, the worlds leading theorist in the field

of cognitive development of children put forth the
cognitive theory in 1952.
According to Piaget, the environment does not
shape child behavior, but the child and adult actively
seek to understand the environment.
Assimilation: - concerns with observing, recognizing,
taking up an object and relating it with earlier
experiences or categories.

Accommodation:Accounts for changing concepts and strategies as a

result for new assimilated information.
Piaget called the strategies and mental categories as

Equilibration:It refers to changing basic assumptions following

adjustments in assimilated knowledge so that the
fact fits better.
Although Piaget does not place much emphasis on the
influence of the psychosocial and psychosexual factors, he
does hold that child development proceeds from an
egocentric position through a predictable manner,

step-wise consistent expansion and incorporation

of learned experiences.

Piaget has delineated four major periods of

cognitive growth, each characterized by distinct type
of thinking.
Sensorimotor stage.
Preoperational stage.
Concrete operational stage.
Formal operational stage.

A) Sensorimotor Stage (birth-18 months): It is the first stage of the four stages of Piagets
He designated the first eighteen months of the
infants life as sensorimotor stage.
During this period, the infants are busy
discovering relationships between their bodies
and the environment.
The child relies on seeing, touching, sucking,
feeling, and using their senses to learn things
about themselves and their environment.

B) The Preoperational Stage(18months- 7 years)

This stage occurs from eighteen months to seven
years of age.
It is divided into two periods.
1) Pre-conceptual period(18months-4 years)
2) Intuitive period(4- 7 years)

Throughout most of the pre-operational stage a

childs thinking is self centered, or egocentric.
According to piaget during the pre- operational
stage a child has difficulty in understanding life from
any perspective other than his own.
In this stage, the child is very me, myself, and I

During this stage, a child begins to reason logically

and organizes thoughts coherently however he can
only think about actual physical objects, he cannot
handle abstract reasoning.
This stage is also characterized by loss of egocentric
thinking, the childs ability to coordinate two
dimensions of an object simultaneously, arrange
structures in sequence and transpose differences
between items in a series.

D) The Formal Operational Stage(12-13 years):It is the fourth and the final stage in Piagets
It begins at 12-13 years of age and continues
throughout the adulthood.
It is characterized by the ability to formulate
hypothesis and systematically test them to arrive

Application Of Piagets Theory:-


Piaget theorized that a child acquisition of reality is

accomplished by touching, exploring and observing.
The child in dental sitting constructs his/her
knowledge about the unknown world of dentistry
through activities such as handling and working with
dental instruments, observing and touching
appliances and smelling various materials.

According to Piagets theory knowledge acquired by

a child produces a state of balance called cognitive
The passage through each developmental stage is
characterized by acquisition of new, more permanent
knowledge about the dental instruments and
This can be utilized by the dentist by encouraging
the child to acquire knowledge about the dental
instruments and techniques.

The dentist must use the curiosity of the child to

gain knowledge in developing a positive dental

3) Animism:-

Using Piagets principle, dental instruments and

materials may be given life like names e.g. a
handpiece could be referred to as whistling barney.
The principle of physiognomic properties is a state
where in child perceives that inanimate objects take
on the form and emotions of human beings.
This phenomenon can be effectively used because fantasy
play and language

when used repeatedly help the child to become

more comfortable.

4) Centering:-

Piaget believed that a child focuses on the most

important characteristics of what he or she sees,
excluding everything else.
During the treatment the child can be given a
mouth mirror to look in. the child should be directed
to focus attention in the mirror , watch the treatment
and concentrate on what is happening.

5) Egocentrism:Piaget believed that children view the world in self

centric manner.
A child believes that his or her point is the only right
This can be put to practical use in the dental clinic
by making the child feel more important.

Hierarchy of Needs:This theory was proposed by Abraham Maslow in

Maslow believed in the self- actualization theory i.e.
the need to understand the totality of a person. He
gave the forward following thoughts:

general type of need is satisfied, another higher

order need will emerge. The desires from most
biologic needs to the more physiological ones
become important only after basic needs have been
Motivation is constantly required and is a never
ending, fluctuating complex present in almost all
Pain avoidance, tension reduction, and pleasure act
as sources of motivating behavior.

Merit of hierarchy of needs:Based on the total personality development.

Demerit of Hierarchy of Needs:This theory is difficult and impractical to apply in

children in dental situations as the child has an ever
changing personality.

Conclusion:These theories help in understanding how

developmental changes occur in the behavior and
understanding of the child. A thorough knowledge of
these theories helps in effective behavior
management of a child in the dental operatory.