Peds 9 - Non-Pharmacological Behavior Management (Dr. Saavedra)

- Psychoanalytic

- Behaviorism

- Cognitive development theory

What are the three classic behavior techniques?

Frued

Who thought of the following theories?

- Children progress through predictable and psychosexual stages of early childhood development

- Child's behavior is oriented to certain parts of their body

Erickson

Who thought of the following theories?

Psychosocial development proceeds by critical steps or psychosocial crisis that shape personality.

Birth-1 year

Erickson's theory of Trust vs Mistrust occurs during which age range?

1-3 years old

Erickson's theory of Autonomy vs Shame/Doubt occurs during which age range?

3-6 years old

Erickson's theory of Initiative vs Guilt occurs during which age range?

7-12 years old

Erickson's theory of Industry vs Inferiority occurs during which age range?

18 years old

Erickson's theory of Identity vs Role Confusion occurs during which age range?

Pavlov

Who thought of the following theories?

Classical Conditioning – one stimulus is associated with another through experience

Skinner

Who thought of the following theories?

Operant- consequence of behavior is in itself stimulus that can affect future behavior

Social learning

Define the following:

Learning can occur through observing others in addition to direct experience

Piaget

Who thought of the following theories?

Examines the development and nature of human intelligence and how humans gradually come to acquire, construct, and use it.

Sensorimotor

What stage of Piaget's Stages of Cognitive development?

- 0-2 years

- Experience is through movement and senses

Preoperational

What stage of Piaget's Stages of Cognitive development?

- 2-7 years

- Children use language literally and are egocentric

Concrete operations

What stage of Piaget's Stages of Cognitive development?

- 7-11 years

- Children can think logically but not abstractly

Formal operations

What stage of Piaget's Stages of Cognitive development?

- 11+ years

- Children can think abstractly and are increasingly concerned about the opinion of others

Contemporary behavior theories

What are all of the following?

- Importance of dental home on behvaior

- Patient and attributes

- Influence of parents

- Parent preferences

- Cultural and ethnic factors

- Environment toxic stress

- Poverty and effects on behavior

- Young age

- Developmental delay/disability

- Interference with communication

- History of poor medical experiences

- Patients with special health care needs

- Inadequate pain control

- Environment of toxic stress/poverty

What are seven potential challenges to cooperative behavior?

2 years old

ID the child age by the developmental milestones:

- Gross motor skills; just developing self-help skills

- Very attached to parent

- Plays alone, rarely shares

- Limited vocabulary

3 years old

ID the child age by the developmental milestones:

- Less egocentric

- Likes to please

- Active imagination

- Closely attached to parent

4 years old

ID the child age by the developmental milestones:

- Tries to impose power

- Develops small social groups

- Expansive period- reaches out from parent

- Many independent self-help skills

5 years old

ID the child age by the developmental milestones:

- Deliberate

- Takes pride in possessions

- Relinquishes comfort objects

- Plays cooperatively with peers

- Children developmental level

- Dental Attitude

- Temperament

- Fears

- Anxiety

- Previous unpleasant experiences

What are 6 predictors of child behaviors?

Temperament

Define the following?

- The behavioral style of an individual while interacting with the surroundings

- A powerful indicator of child's response to dental treatment

True

T/F: Both age and temperament seem to act as predictors of child behavior in the dental setting

Fear

______ arises when there is a perceived lack of control or potential for pain, especially when a child is aware of a dental problem. Ex: history of painful health care experience

Fear

If the level of ______ is incongruent with the circumstances and the patient is not able to control impulses, disruptive behavior is likely

Anxiety

Define the following:

- Dental visit will evoke some degree of apprehension

- This will come from fear of pain, injury and separation

- A normal reaction that helps protect an individual

- Children have COPING skills which helps them to tolerate the experience

- Subjective (Others) Vs. Objective (Self) fears influence the child's reaction to the dental experience

pain

______ has a direct influence on behavior

True

T/F: During a dental appointment, you must distinguish between disruptive behavior due to fear and anxiety OR due to painful stimuli

pain

When a child has "screwing up eyes and lowers the eyebrows," they are most likely experiencing ________

anxiety

When a child opens eyes wide and raises the eyebrows, they are most likely experiencing ________

true

T/F: A child's attitude towards dentistry has an effect on aspects of the appointment like anxiety and pain

16%

In the Stricker and Howit study, only ___% of children had anxiety from dentistry

More

Pain response is different in children, the younger children are, the ________ sensitive to pain reaction

Frankl 4 ++

ID the Frankl Scale score:

- Definitely positive

- Good rapport

- Interest in dental procedures

- Laughs and enjoys

Frankl 3 +-

ID the Frankl Scale score:

- Positive

- Accepts treatment but may be cautious or reserved

- Follows directions

Frankl 2 -+

ID the Frankl Scale score:

-Negative

- Reluctant

- Timid

- Uncooperative

Frankl 1 --

ID the Frankl Scale score:

- Definitely negative

- Refusal of treatment

- Defiant

- Unable to cooperate

behavior management

Define the following:

The means by which the dental health team effectively and efficiently performs treatment for a child and at the same time, instills a positive dental attitude

- Establish communication

- Alleviate fear and anxiety

- Deliver quality dental care

- Build a trusting relationship between dentist and child

- Promote the child's positive attitude towards oral/dental health

What are the 5 goals of behavioral management in dental health?

- Tell-Show-Do

- Positive Reinforcement

- Distraction

- Voice Control

- Escape (not used often)

- Direct observation/modeling

- Parent Presence/Absence

What are seven ways to incorporate communicative behaviors into a dental procedure with children?

false, used with both cooperative and uncooperative children

T/F: Communicative management is only used in uncooperative patients

Communicative management

What has the following characteristics?

- Most fundamental form of behavior management.

- Establishes a relationship with the child which may allow the successful completion of dental procedures

- Helps with developing of a positive attitude toward dental health

- The sender

- The message, including facial expression and body language of the sender

- The context or the setting in which the message is sent

- The receiver

For communicative management to take place, what 4 elements must be present?

Commanding

What communication basic practice is when you speak directly to the child, Be child focused, Get eye contact

(Ex: It is time to....., You need to.....)?

Concise

What communication basic practice is when you use simple vocabulary, short message, ex: limit number of instructions?

Concrete

What communication basic practice is when you say what you mean, don't ask questions if there isn't a choice?

Wind gun

What is a word substitute for the following dental terminology?

Air Syringe

Water gun

What is a word substitute for the following dental terminology?

Water Syringe

- Mr. Thirsty

- Vacuum cleaner

What is a word substitute for the following dental terminology?

Suction

Cavity fighter (Vitamins)

What is a word substitute for the following dental terminology?

Topical Fluoride gel

- Tooth paint

- Nail polish

What is a word substitute for the following dental terminology?

Sealant

Jelly, sleepy jelly

What is a word substitute for the following dental terminology?

Topical anesthesia

Sleepy juice

What is a word substitute for the following dental terminology?

Local anesthesia injection

Tooth pillow

What is a word substitute for the following dental terminology?

Mouth Prop (mouth Gag)

Tooth ring

What is a word substitute for the following dental terminology?

Rubber Dam clamp

Rain coat

What is a word substitute for the following dental terminology?

Rubber dam

Hanger

What is a word substitute for the following dental terminology?

Rubber dam frame

Whistle

What is a word substitute for the following dental terminology?

High speed

Mr. Bumpy

What is a word substitute for the following dental terminology?

Low speed

Tell, Show, Do

ID the communicative behavioral guidance technique:

- Verbal explanation of procedure in language that is appropriate for age/development of child.

- Allow child to physically interact with aspects of procedure via senses.

- Perform procedure

Children with communicative/interactive ability, can be used with any child

Who is the tell-show-do communication technique most effective for?

- Hearing impaired patients

- <12 years old

What are two contraindications for using the Tell-show do method?

Positive Reinforcement

ID the communicative behavioral guidance technique:

- Rewards desired behavior

- Best when immediate-concept

- Requires consistency and avoid rewarding undesirable behavior

- Realization that the desired behavior may be less than totally desired but its still a positive step to be recognized

positive reinforcement

Giving a child a compliment or a sticker for a job well done is an example of what communicative behavioral guidance technique?

Distraction

ID the communicative behavioral guidance technique:

- Attention is directed from dental procedure

- Affects pain perception

- Dental applications: videogames, headphones, storytelling

Distraction

The following are all examples of what communicative behavioral guidance technique?

- Verbal: Talking with child about favorite sport during injection

- Audio/Visual: Music or TV

- Physical: Gently shaking cheek during injection

Voice control

ID the communicative behavioral guidance technique:

- Controlled alteration of voice to direct behavior

- - Volume

- - Tone

- - Pace

- Highly effective in reducing disruptive behaviors

Punished

The study on voice control concluded that loud voice control leads patients to feel how?

Voice control

In the study by Greenbaum et al in 1990 what was rated as unacceptable by parents?

Parental presence/absence

ID the behavioral guidance technique:

- Indicated in any patient who has the potential to be cooperative

- Utilizing presence or absence of parent to gain the child's cooperation

- Most common technique involves a previously cooperative child who becomes un-cooperative and practitioner ask parents to leave operatory until child becomes compliant

- With parents who are unwilling/unable to extend effective support

- With a child unable to understand that parent's presence is contingent on cooperation

When is the Parental presence/absence contraindicated?

Direct observation/modeling

ID the behavioral guidance technique:

- Patient observes another patient, parent, or sibling exhibiting cooperative behavior during dental treatment.

- Can be achieved through live patient modeling or video

- Protective stabilization

- Sedation

- General anesthesia

What are three advanced behavior guidance techniques discussed in lecture?

Protective stabilization

ID the advanced behavior guidance technique:

- Reduce unwanted movement

- Protect patients, parent, dentist, staff from injury

- Facilitates dental care delivery

Protective stabilization

These are indications for which advanced behavior guidance technique:

- Limited treatment or immediate assessment needed in child who is pre-cooperative and mentally disabled

- Safety of dentist, patient, staff is at risk

Protective stabilization

These are contraindications for which advanced behavioral guidance technique?

- Medical or physical condition which prevents safe stabilization

- Previous psychological trauma related to stabilization

- Cooperative non-sedated patients

- Non-Sedated uncooperative patients with lengthy dental needs

Protective stabilization

These are precautions for which advanced behavioral guidance technique?

- Tightness and duration of stabilization should be monitored

- Stabilization must not compromise circulation or respiration

- Stabilization must be ceased in a hysterical patient who does not want to settle down

Sedation

ID the advanced behavior guidance technique:

- Medication used on a child in a more calm and relaxed state, but patient is still able to breathe normally on their own and respond to stimuli

General Anesthesia

ID the advanced behavior guidance technique:

- The dentist performs the dental treatment with the child anesthetized in a controlled state of unconsciousness in a hospital or ambulatory setting

- Risks

- Benefits

- Alternatives of behavior guidance

Informed consent should be presented in a language easy for parents understanding and should address what three things?

false, advance behavior management requires a separate informed consent

t/f: you do not need a separate informed consent to use one of the advanced behavior management techniques

Frankl 3 & 4

Patients that exhibit which Frankl score may be considered for basic behavior guidance techniques?

Frankl 1 & 2

Patients that exhibit which Frankl score may be considered for advanced behavior guidance techniques?

sedation

What is the most acceptable behavorial technique by parents?

Life threatening

Treatment can be deferred when dental disease is usually not _________

True

T/F: Treatment can be deferred if the patients behavior can not help in precluding treatment safely and efficiently

Risks and benefits

Treatment can be deferred even if procedure started, but what do you have to discuss?