Social and Behavioral Development

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Social and
Behavioral
Development
September 30, 2021 JOHN PATRICK F. BALUYUT D.M.D.
MS
Overview
Social and Behavioral Development
• Process by which behavior can be learned
• Structural substrate of behavior
⚬ How it relates both to the organization of the nervous
system at various stages
⚬ Emotional components underlying the expression of
behavior
GROWTH AND DEVELOPMENT
• Relevance of the theoretical concepts to the day-to-day

treatment of patients is emphasized
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Learning and the

Development of Behavior
Three Distinct Mechanisms by which Behavioral Responses are Learned:
• Classical Conditioning
• Operant Conditioning
• Observational Learning
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Learning and the

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Development of
Behavior
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Learning and the

Classical Conditioning
• First described by the Russian physiologist Ivan Pavlov

• He postulated that this behavioral mechanism operates by the simple process of
association of one stimulus with another
• "Learning by Association"
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Learning and the

• Associations of this type tend to become generalized

• Therefore it is recommended that behavior management in the dentist’s office is
easier if the dental office looks as little like the typical pediatrician’s office or
hospital clinic as possible
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Learning and the TH
• Extinction of the Conditioned Behavior

⚬ Phenomenon wherein the association between a conditioned and unconditioned
response is not reinforced
⚬ This becomes the basis for a "Happy Visit to the dentist following a stressful
visit
⚬ If the conditioned association of pain with the doctor’s office is strong, it can
take many visits without unpleasant experiences and pain to extinguish the
associated crying and avoidance
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Learning and the

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• Discrimination
⚬ Generalization of a conditioned stimulus
⚬ The conditioned association of white coats with pain can easily be generalized
to any office setting
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Learning and the

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Operant Conditioning
• Postulated by B.F. Skinner a behavioral theorist

• viewed conceptually as a significant extension of classical conditioning
• Explain many aspects of social behavior far too complicated to be understood from
the perspective of classical conditioning
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Learning and the

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• Basic principle of operant conditioning is that the consequence of a behavior is in

itself a stimulus that can affect future behavior
• A response becomes a further stimulus
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Learning and the

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• The general rule is that if the consequence of a certain response is pleasant or

desirable, that response is more likely to be used again in the future; but if a
particular response produces an unpleasant consequence, the probability of that
response being used in the future is diminished
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Learning and the TH
• Positive Reinforcement
⚬ If a pleasant consequence follows a
response, the response has been positively
reinforced, and the behavior that led to this
pleasant consequence becomes more likely
in the future
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Learning and the

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• Negative Reinforcement
⚬ Involves the withdrawal of an unpleasant stimulus after a response
⚬ Refers to the fact that the response that is reinforced is a response that leads to
the removal of an undesirable stimulus
*Note that negative reinforcement is not a synonym for punishment

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Learning and the

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• In dental practice, it is important to reinforce only desired behavior, and it is equally

important to avoid reinforcing behavior that is not desired
• An interesting study showed that an alternative scheduled time-out was as
successful as an operant conditioning approach to controlling behavior problems
during prolonged dental appointments for children
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Learning and the

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• Omission
⚬ Also called "Time-Out"
⚬ Involves removal of a pleasant stimulus after a particular response
⚬ 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
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Learning and the

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• Punishment
⚬ Occurs when an unpleasant stimulus is presented after a response.
⚬ Decreases the probability that the behavior that prompted punishment will occur
in the future
⚬ It is effective at all ages, not just with children
⚬ Has traditionally been used as a method of behavior modification in children,
more so in some societies than others
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Learning and the

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• In general, positive and negative reinforcement are the most suitable types of
operant conditioning for use in the dental office
• Both types of reinforcement increase the likelihood of a particular behavior
recurring, rather than attempting to suppress a behavior as punishment and omission
do
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• Older children are just as susceptible to positive reinforcement as younger ones

⚬ Adolescents in the orthodontic treatment age, for instance, can obtain positive
reinforcement from a simple pin saying “World’s Greatest Orthodontic Patient”
⚬ A reward system can also be possibly used
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• Negative reinforcement is more difficult to use as a behavioral management tool in

the dental office, but it can be used effectively if the circumstances permit
⚬ In orthodontic treatment, long bonding and banding appointments may go more
efficiently and smoothly if the child understands that his helpful behavior has
shortened the procedure and reduced the possibility that the procedure will need
to be redone
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Learning and the

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• The other two types of operant conditioning, omission and punishment, should be
used sparingly and with caution in the dental office
⚬ If a positive stimulus is removed in omission, the child may react with anger or
frustration
⚬ When punishment is used, both fear and anger sometimes result.
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Learning and the

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• One mild form of punishment that can be used with children is Voice control
⚬ It involves speaking to the child in a firm voice to gain his attention
⚬ Telling him that his present behavior is unacceptable
⚬ Directing him as to how he should behave
*This technique should be used with care, and the child should be immediately rewarded
for an improvement in his behavior
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Observational Learning (Model)
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• Certainly seems that much of a child’s behavior in a dental office can be learned
from observing siblings, other children, or even parents
• Two Distinct Stages in observational learning:
⚬ Acquistion
⚬ Performance
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• Children are capable of acquiring almost any behavior that they observe closely and
that is not too complex for them to perform at their level of physical development
⚬ A parent or older sibling is often the object of imitation by the child
• Parent is an important role model for a young child, the mother’s attitude toward
dental treatment is likely to influence the child’s approach
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• If a young child observes an older sibling undergoing dental treatment without

complaint or uncooperative behavior, he or she is likely to imitate this behavior
• If the older sibling is observed being rewarded, the younger child will also expect a
reward for behaving well
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• Both children and adolescents do better, it appears, if they are treated in open clinics
rather than in private cubicles, and observational learning plays an important part in
this
• A dentist of course hopesthat the patient waiting for treatment observes appropriate
behavior and responses on the part of the patient who is being treated, which will be
the case in a well-managed clinical setting
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Stages of Emotional and

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Cognitive Development
Emotional Development
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• Development of Basic Trust (Birth to 18 Months)

• Successful development of trust depends on a caring and consistent mother or
mother substitute
• it is important that a strong bond develop between parent and child
• Physical growth can be significantly retarded unless the child’s emotional needs are
met by appropriate mothering
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• "Maternal Deprivation"
⚬ infants fail to gain weight and are retarded in their physical, as well as
emotional, growth
⚬ Unstable mothering that produces no apparent physical effects can result in a
lack of sense of basic trust
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• "Separation Anxiety"
⚬ Tight bond between parent and child
⚬ If it is necessary to provide dental treatment at an early age, it usually is
preferable to do so with the parent present and, if possible, while the child is
being held by one of the parents
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• "Separation Anxiety"
⚬ a child who never developed a sense of basic trust will have difficulty entering
into situations that require trust and confidence in another person
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2. Development of Autonomy (18 Months to 3 Years)

• Children around the age of 2 often are said to be undergoing the “terrible twos”
• Child is moving away from the mother and developing a sense of individual identity
or autonomy
• He or she varies between being a little devil who says no to every wish of the
parents and insists on having his own way and being a little angel who retreats to the
parents in moments of dependence
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Stages of Emotional and TH
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• Failure to develop a proper sense of autonomy results in the development of doubts
in the child’s mind about his ability to stand alone, and this in turn produces doubts
about others
*Autonomy in control of bodily functions is an important part of this stage

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• This stage is considered decisive in producing the personality characteristics of love
as opposed to hate, cooperation as opposed to selfishness, and freedom of
expression as opposed to self-consciousness
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• A key toward obtaining cooperation with treatment from a child at this stage is to
have the child think that whatever the dentist wants was his or her own choice, not
something required by another person
• Allowing the parent to be present during treatment may be needed for even the
simplest procedures
• Complex dental treatment of children at this age is quite challenging and may
require extraor- dinary behavior management strategies such as sedation or general
anesthesia.
3. Development of Initiative (3-6 Years)

• The initiative is shown by physical activity and motion, extreme curiosity and
questioning, and aggressive talking
• A child is inherently teachable
• We should channel the increase in activity into manageable tasks, arranging things
so that the child is able to succeed, and preventing him or her from undertaking
tasks where success is not possible
3. Development of Initiative (3-6 Years)

• For most children, the first visit to the dentist comes during this stage of initiative
• Going to the dentist can be constructed as a new and challenging adventure in which
the child can experience success
• A child at this stage will be intensely curious about the dentist’s office and eager to
learn about the things found there
4. Mastery of Skills (7-11 Years)

• The child is working to acquire the academic and social skills that will allow him or
her to compete in an environment where significant recognition is given to those
who produce
• The child is learning the rules by which that world is organized
• Able to aquires industriousness and begins the preparation for entrance into a
competitive and working world
• Influence of parents as role models decreases, and the influence of the peer group
increases

• "Sense of Inferiority"
⚬ A child who begins to compete academically, socially, and physically is certain
to find that others do some things better and that whatever he or she does best,
someone does it better
• it is important for responsible adults to attempt to structure an environment that
provides chal- lenges that have a reasonable chance of being met, rather than those
that guarantee failure

• Orthodontic treatment often begins during this stage of development
• A key to behavioral guidance is setting attainable intermediate goals, clearly
outlining for the child how to achieve those goals, and positively reinforcing success
in achieving these goals

• Orthodontic treatment in this age group is likely to involve the faithful wearing of
removable appliances
⚬ Determined in large part by whether he or she understands what is needed to
please the dentist and parents
⚬ Whether the peer group is supportive
⚬ Whether the desired behavior is reinforced by the dentist
• Motivation is usually taken from peers if they are supportive
5. Development of Personal Identity (12-17Years)

• "Adolescence"
⚬ a period of intense physical development
⚬ Also the stage in psychosocial development in which a unique personal identity
is acquired
• This sense of identity includes both a feeling of belonging to a larger group and a
realization that one can exist outside the family

• "Adolescence"
⚬ Most orthodontic treatment is carried out during the adolescent
⚬ years, and behavioral management of adolescents can be extremely challenging
⚬ Orthodontic treatment should be instituted only if the patient wants it, not just to
please the parents

• Motivation for seeking treatment can be defined
⚬ Internal
⚬ External
• It is extremely important for an adolescent to actively desire the treatment as
something being done for—not to—him or her
6. Development of Intimacy (Young Adult)

• Successful development of intimacy depends on a willingness to compromise and
even to sacrifice to maintain a relationship.
• Success leads to the establishment of affiliations and partnerships, both with a mate
and with others of the same sex, in working toward the attainment of career goals
6. Development of Intimacy (Young Adult)

• A growing number of young adults are seeking orthodontic care. Often, these
individuals are seeking to correct a dental appearance they perceive as flawed
• They may feel that a change in their appearance will facilitate attainment of intimate
relationships
• Important to discuss the psychologic impact of orthodontic treatment with a young
adult patient before beginning therapy
7. Guidance of Next Generation (Adult)

• Becoming a successful and supportive parent is obviously a major part of this, but
another aspect of the same responsibility is service to the group, community, and
nation
• The next generation is guided, in short, not only by nurturing and influencing one’s
own children but also by supporting the network of social services needed to ensure
the next generation’s success
8. Attainment of Integrity (Late Adult)

• The individual has adapted to the combination of gratification and disappointment
that every adult experiences
• The feeling of integrity is best summed up as a feeling that one has made the best of
this life’s situation and has made peace with it
• the theory of cognitive development is strongly associated with one dominant

individual, Jean Piaget
• The development of intelligence is another example of the widespread phenomenon
of biologic adaptation
⚬ Every individual is born with the capacity to adjust or adapt to both the physical
and the sociocultural environments in which he or she must live
• Intelligence develops as an interplay between assimilation and accommodation

• It is important to realize that the time frame is variable, especially for the later ones
• Some adults never reach the last stage
• To communicate successfully with a child, it is necessary to understand his or her
intellectual level and the ways in which thought processes work at the various stages
• Orthodontic care is one of the few dental treatments that includes active patient (and
parent) involvement beyond keeping the teeth clean
• Cognitive development is essential in order to have successful orthodontic care
Cognitive Development Stages
• Sensorimotor Period
• During the first 2 years of life, a child develops from a newborn infant who is
almost totally dependent on reflex activities to an individual who can develop new
behaviors to cope with new situations
• The child develops rudimentary concepts of objects, including the idea that objects
in the environment are permanent
• a child has little ability to interpret sensory data and a limited ability to project
forward or backward in time
2. Preoperational Period
• Begin to use language in ways similar to adults
• the capacity develops to form mental symbols representing things and events not
present, and children learn to use words to symbolize these absent objects
• A prominent feature of this stage is the concrete or literal nature of their language
• Children use and understand language in a literal sense and thus understand words
only as they have learned them
• They are not able to comprehend more than the literal meaning of idioms, and
sarcastic or ironic statements are likely to be misinterpreted
• "Egocentrism"
⚬ Meaning that the child is incapable of assuming another person’s point of view
⚬ His own perspective is all that he can manage
• "Animism"
⚬ Investing inanimate objects with life
⚬ In the dental setting this can be used to the dental team’s advantage by giving
dental instruments and equipment lifelike names and qualities
• With a child at this stage, the dental staff should use immediate sensations rather
than abstract reasoning in discussing concepts such as prevention of dental problems
• He or she 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.
3. Period of Concrete Operations

• He or she can use a limited number of logical processes, especially those involving
objects that can be handled and manipulated
• The child’s thinking is still strongly tied to concrete situations, and the ability to
reason on an abstract level is limited
• By this stage, the ability to see another point of view develops, while animism
declines
3. Period of Concrete Operations

• Presenting ideas as abstract concepts rather
than illustrating them with concrete objects
can be a major barrier to communication
4. Period of Formal Operations

• The child’s thought process has become similar to that of an adult, and the child is
capable of understanding concepts such as health, disease, and preventive treatment
• Intellectually the child can and should be treated as an adult
• Successful communication, in other words, requires a feel for the child’s stage of
intellectual development

• "Imaginary Audience"
⚬ They feel as though they are constantly “on stage,” being observed and
criticized by those around them
⚬ When an adolescent considers what others are thinking about
⚬ it is a powerful influence on young adolescents, making them quite self-
conscious and particularly susceptible to peer influence

• In the dental setting, the reaction of the imaginary audience to braces on the teeth, of
course, is an important consideration to a teenage patient
• Pleas for tooth-colored plastic or ceramic brackets (to make them less visible and
more esthetic); at other times, brightly colored ligatures and elastics have been
popular

• "Personal Fable"
⚬ This concept holds that “because I am unique, I am not subject to the
consequences others will experience.”
⚬ A powerful motivator that allows us to cope in a dangerous world

• Drawbacks of "Imaginary Audience" and "Personal Fable"
⚬ The imaginary audience, depending on what the adolescent believes, may
influence him or her to accept or reject treatment and to wear or not wear
appliances
⚬ The personal fable may make a patient ignore threats to health such as
decalcification of teeth from poor oral hygiene during orthodontic therapy

• The challenge for the dentist is not to try to impose change on reality as perceived
by adolescents, but rather to help them more clearly see the actual reality that
surrounds them
• A useful approach to this age group would be to agree with him that he may be right
in what others will think but ask him to give it a try for a specified time

• One role of an effective dental professional is to help teenagers test the reality that
actually surrounds them
• It is the job of the orthodontist as well as the family dentist to carefully evaluate the
development of the child and to adapt his or her language so that concepts are
presented in a way that the patient can understand them
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Thank you!
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I TH

• Relevance of the theoretical concepts to the day-to-day

Learning and the

Learning and the

Learning and the

• First described by the Russian physiologist Ivan Pavlov

Learning and the

• Associations of this type tend to become generalized

• Extinction of the Conditioned Behavior

Learning and the

Learning and the

• Postulated by B.F. Skinner a behavioral theorist

Learning and the

• Basic principle of operant conditioning is that the conse- quence of a behavior is in

Learning and the

• The general rule is that if the consequence of a certain response is pleasant or

Learning and the

*Note that negative reinforcement is not a synonym for punishment

Learning and the

• In dental practice, it is important to reinforce only desired behavior, and it is equally

Learning and the

Learning and the

Learning and the

Learning and the

• Older children are just as susceptible to positive reinforcement as younger ones

Learning and the

• Negative reinforcement is more difficult to use as a behavioral management tool in

Learning and the

Learning and the

Learning and the

Learning and the

Learning and the

Learning and the

• If a young child observes an older sibling undergoing dental treatment without

Learning and the

Learning and the

Stages of Emotional and

Stages of Emotional and

• Development of Basic Trust (Birth to 18 Months)

Stages of Emotional and

• Development of Basic Trust (Birth to 18 Months)

Stages of Emotional and

• Development of Basic Trust (Birth to 18 Months)

Stages of Emotional and

• Development of Basic Trust (Birth to 18 Months)

Stages of Emotional and

2. Development of Autonomy (18 Months to 3 Years)

Stages of Emotional and

2. Development of Autonomy (18 Months to 3 Years)

*Autonomy in control of bodily functions is an important part of this stage

Stages of Emotional and

2. Development of Autonomy (18 Months to 3 Years)

2. Development of Autonomy (18 Months to 3 Years)

3. Development of Initiative (3-6 Years)

3. Development of Initiative (3-6 Years)

4. Mastery of Skills (7-11 Years)

4. Mastery of Skills (7-11 Years)

4. Mastery of Skills (7-11 Years)