BEHAVIOUR CLASSIFICATIONS

Numerous systems have been developed for classifying the behaviour of children in the dental environment. The knowledge of these systems can be an asset to the pedodontist in several ways. 1. It can assist in directing the management method. 2. It can provide a means for systematically recording behaviours. 3. It can assist in evaluating the validity of current research.

I) WRIGHTS CLASSIFICATION 1975:

A.CO-OPERATIVE:(POSITIVE BEHAVIOR) 1) CO-OPERATIVE BEHAVIOR Most children seen in dental offices are co-operative. They are reasonably relaxed and have minimal apprehensions. They have good rapport with the dentist and are interested in the dental procedures, often laughing and enjoying the situation. They present a reasonable level of co-operation, which allows the dentist to function effectively and efficiently. 2)LACKING CO-OPERATIVE ABILITY: Includes very young children (less than 2 years). Because of their age, these children have been referred to as being in the pre co-operative period. They can pose major behavioral problems. A second group of children who lack co-operative ability are those with specific debilitating or handicapping conditions that prohibits co-operation. 3) POTENTIALLY COPERATIVE

Has the potential to cooperate, but because of the interent fear (subjective /objective) the child does not cooperate. B .UNCO-OPERATIVE BEHAVIOR :( NEGATIVEBEHAVIOR) Child has behavioural problem which can be modified. That is, the child can become cooperative. These potentially co-operative children are characterized as 1. Uncontrolled behaviour: Also labeled asIncorrigible. Usually seen in the young child age 3 to 6. The reaction is in the form of tantrum, may begin in the reception area or even before the child enters the dental office. Characterized by tears, loud crying, physical lashing out and flailing of the hands and legs. If this type of behaviour occurs in the older child, there are probably deep-rooted reasons for it. 2. Defiant behaviour: This type of behaviour has been referred to as stubborn or spoiled. More typically seen in the elementary school group. Is distinguished by I dont want to, I dont have to, or I wont. It can be passive if, it is seen in older children approaching adolescent. The child refuses to respond verbally, failure of communication results and may reject the situation by clenching the teeth. Once own over, these children frequently become highly co-operative. 3. Timid behavior:

Timidity is milder, when compared to other behavioral forms. If managed incorrectly, can deteriorate to uncontrolled. The child is highly anxious, may shield behind a parent. Usually fail to offer great physical resistance to the separation procedures. Some may hesitate when given directions. May whimper but will not cry hysterically. Do not always hear or comprehend instructions, because the child may come from an overprotective home environment or may live in an isolated area and have little contact with strangers. So instructions must be given slowly and repeated. 4. Tense co-operative behavior: These children accept treatment but are extremely tense. A tremor may be heard when they speak. They may perspire noticeably on the palms of the hands or brow. They control their emotions. These children may grow up accepting dentistry but voicing dislike out of proportion to their personal experience. 5. Whining behavior: Some children have been described as whiners. These children allow the dentist to proceed but whine throughout the entire procedure. The cry is controlled, constant, and not particularly loud. They frequently complain of pain.

Such children can be exasperating. Their continuing reactions are source of frustration and irritation to those involved with the treatment. Great patience is required when dealing with whining children. 6)Stoic behaviour: This child might generally be considered to be co-operative. He sits quietly and passively and accepts all dental treatment. Attention is called to this behaviour pattern because it is characteristic of children who have been physically abused. The dentist noting this behaviour should be attentive to other signs of abuse and should notify authorities if indicated.

II) LAMPSHIRES CLASSIFICATION - 1970:

1)CO-OPERATIVE: physically and emotionally co-opeerative regardless of treatment

TENSE CO-OPERATIVE: co-operative but tensed. Tension may be unnoticed 1. OUTWARDLY APPREHENSIVE: hides behind mother, avoid looking or talking to dentist eventually accept treatment. 2. FEARFUL: require considerable support. Modeling, desensitization and other behaviour modifications become necessary. 3. 4. 5. STUBBORN OR DEFIANT: resist or try to avoid treatment. HYPERMOTIVE: actually agitated, scream and start fighting. HANDICAPPED: physically, mentally or emotionally handicapped.

6. Emotionally immature.

III) MC DONALD AND AVERY CLASSIFICATION -1983: Mc Donald and Avery consider 1. Children who are Cooperate 2. Children who are unable to cooperate 3. Children who have the potential to cooperate. 3 groups of children:

IV) WALTERS CLASSIFICATION

Walter cites 3 types of behaviour: 1. Negative 2. Indefinite 3. Positive. V) WILSON (1933)

1996:

a) Normal or bold :- The child is brave enought to face new situation ,is co-operative ,friendly with the dentist b) Tasteful or timid: - The child is shy, but does not interfere with the dental procedures. c) Hyserical or rebellious :- Child is influenced by home environment - throw temper tantrum and is rebellious d) Nervous or fearful: - The child is tense and anxious, fears dentistry. VI) Garcia Godoy (1986) 1) Fearful: - resists entering treatment room, cries, screams. Could be passive, accepting treatment but will state his fear to treatment. 2) Timid: enters treatment cautiously. Thoughtful with eyes on floor. Does not look at professional staff when talked to. 3) Spoiled: enters clinic with arrogant and proud behaviour. Neglects treatment and states preferences on treatment, gives order.

4) Aggressive: screams, does not open mouth, kicks, sits on dental chair and neglects treatment. 5) Adopted: combination of spoiled and fearful behaviour. Could present with timid characteristics. 6) Handicapped: all children with mental or physical handicapping conditions; will need special care and this will manifest in behaviour. 7) Cooperative: cooperate with treatment.

VII) Frankl et al. Behavioral scale with Wright's modification adapted from Wright (1975): ----------------------------------------------------------------------------------------------Rating Frankl behavior rating scale Wright Modification

------------------------------------------------------------------------------------------------------Rating No.1 Definitely negative Refusal of treatment; crying forcefully Fearful, extreme negativism Rating No.2 Negative Reluctant, uncooperative, limited Negativism, sullen, withdrawn Rating No.3 Positive Accepts treatment but may be (+) (-) (- -)

Cautious or reserved, follows Directions. Rating No. 4 Definitely positive Good rapport, interested in dental Procedures, laughs and enjoys ----------------------------------------------------------------------------------------------------(+ +)

PATIENT BEHAVIOR RATINGS BASED ON WORK OF FRANKL AND WRIGHT: Rating no 1: definitely negative (-,-): 1. Refuses treatment. A. Immature behaviour: cannot Toddler or early preschooler The special child. B. uncontrollable behaviour: is essentially a temper tantrum, suggestive of extreme anxiety. Preschooler or middle years child. C. Defiant behaviour: May be active-or passive-type resistance. Lampshire (1970) termed this behaviour that of the "spoiled" child, also associated with Stubbornness. Middle years child (one nearing adolescence) 2. Cries forcefully A. Uncontrollable behaviour: reason or cope with situations,

Late preschooler or middle years child. 3. Is extremely negative, associated with fear. A. Uncontrollable behaviour: may be exhibited, for example, in the "older" young person possessing deep-seated emotional problems (Wright, 1975) B. Defiant behaviour: includes passive resistance in the individual approaching adolescence. Rating no 2: negative (-): 1. Is reluctant to accept treatment A. Immature behaviour Toddler or preschooler: too young in years The special child. B. Timid behaviour: seen in the child who is over protected, exposed to few people (as observed in children from sparsely populated areas), by

Strange environment; this type of child may revert to uncooperative behaviour if mismanaged (Wright, 1975). C. Influenced behaviour: includes family and peer pressure. 2. Displays evidence of slight negativism. A. Timid behaviour: must be taught confidence in himself or

D. Timid behaviour: follows the dentist's directions in a shy, quiet manner. directions but may be hesitant Rating no 4: definitely positive (+ +): Unique behaviour: looks forward to and understands the importance of good preventive care.

herself and dentist (Wright be 1975) B.Whinning behaviour: Preschooler and middle year child. Ratingno3: positive (+): 1.Accepts treatment. A) Tense cooperative behaviour: observed in all developmental ages; follows the dentist but may be hesitant & cautious (Lampshire, 1961) B) Concretive behaviour: responds harmoniously C.Whining behaviour: may or may not be considered negative behaviours

BEHAVIOR MANAGEMENT BE CLASSIFIED AS:

CAN

y y

NONPHARMACOLOGICAL (PSYCHOLOGICAL) PHARMACOLOGICAL

NONPHARMACOLOGICAL MANAGEMENT
1) COMMUNICATION

METHODS

OF

BEHAVIOR

2) BEHAVIOR SHAPING ( MODIFICATION) a)DESENESITIZATION a) MODELLING b) CONTINGENCY MANAGEMENT

3) BEHAVIOR MANAGEMENT
A) AUDIO-ANALGESIA B) BIOFEEDBACK C) VOICE CONTROL D) HYPOSIS E) HUMOR

F) COPING G) RELAXATION H) IMPLOSION THERAPY

I) AVERSIVE CONDITIONING