RESUMO
Voice control, a punishment technique based on loud commands, has been used widely in pediatric dentistry. This study examined whether (a) loudness is a necessary component of the technique, (b) voice control actually reduces children's disruptive behavior, and (c) after treatment, children's negative affect increases. Subjects were forty 3 1/2- to 7-year-olds who posed potential behavior problems and who were scheduled for cavity restoration. Children were assigned randomly to either loud- or normal-voice groups. Children who were assigned to either group but who were not disruptive formed a nonexperimental control group. Prior to and after treatment, children reported their feelings using the Self-Assessment Mannequin. Disruptive behavior was scored using the Behavior Profile Rating Scale. Results indicated that, following loud, but not normal voice commands, children reduced their disruptive behavior (p less than .004) and self-reported lower arousal (p less than .09) and greater pleasure (p less than .10). Theoretical and practical implications of these findings are discussed.
Assuntos
Transtornos do Comportamento Infantil/psicologia , Relações Dentista-Paciente , Medo , Cooperação do Paciente/psicologia , Reforço Verbal , Qualidade da Voz , Nível de Alerta , Criança , Pré-Escolar , Restauração Dentária Permanente , Feminino , Humanos , MasculinoRESUMO
Evaluated the effect of varied physician affect on subject recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. Forty women at risk for breast cancer viewed videotapes of an oncologist presenting--with either worried or nonworried affect--mammogram results. Although the mammogram results and the oncologist were the same in both presentation, analyses indicated that, compared to the women receiving the results from a nonworried physician, the women receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. These results suggest that physician affect plays a critical role in patient reaction to medical information. Implications for compliance research, patient satisfaction, and physician training are discussed.
Assuntos
Afeto , Ansiedade/psicologia , Neoplasias da Mama/psicologia , Rememoração Mental , Educação de Pacientes como Assunto , Adulto , Nível de Alerta , Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Mamografia/psicologia , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Maternal influences on children's fear and coping behaviors during a medical examination were studied in a pediatric outpatient clinic using the Dyadic Prestressor Interaction Scale (DPIS) to measure anticipatory reactions just prior to contact with the physician. Analysis of 50 mother-child dyads, including children from 4 to 10 years of age, revealed that the behaviors emitted by mother and child are likely to influence the child's ability to tolerate the medical experience. Maternal use of distraction and low rates of ignoring were associated with lower child distress and increased prosocial behaviors. Children's active exploration of the situation was more likely to occur when mothers provided their children with information, and was less likely when mothers reassured their children. Maternal reassurance of children and overt maternal agitation were associated with more maladaptive child responses. Age trends were also found in interactive patterns. Younger children were more likely to receive reassurance from mothers when they showed attachment. There was a stronger association between mother's information giving and child's exploring for children under 5 years, 9 months of age. Results supported the usefulness of the DPIS for investigation of child management techniques in this situation. Theoretical extension to attachment and stranger-approach situations was made. Suggestions for future studies to clarify the reciprocity of interactions or to determine causal direction between mother and child behaviors, as well as to evaluate the specificity or generality of these findings, were provided.
Assuntos
Serviços de Saúde da Criança , Relações Mãe-Filho , Estresse Psicológico/psicologia , Fatores Etários , Ansiedade/psicologia , Criança , Pré-Escolar , Comportamento Exploratório , Medo , Feminino , Humanos , Masculino , Apego ao ObjetoRESUMO
Sixteen inner city children attending a pedodontic clinic were shown either a filmed demonstration of a child model cooperatively undergoing dental treatment or a film unrelated to dental activity. The group viewing the modeling film showed significantly fewer disruptive behaviors during restorative care and were rated as less fearful than the control group.
Assuntos
Ansiedade/prevenção & controle , Terapia Comportamental , Comportamento Infantil , Comportamento Cooperativo , Criança , Pré-Escolar , Humanos , Comportamento Materno , Filmes Cinematográficos , Testes PsicológicosRESUMO
In a first study, phobic volunteer subjects (N = 60) reacted psychophysiologically with greater vigor to imagery of their own phobic content than to other fearful or nonaffective images. Imagery heart rate responses were largest in subjects with multiple phobias. For simple (dental) phobics, cardiac reactivity was positively correlated with reports of imagery vividness and concordant with reports of affective distress; these relationships were not observed for social (speech) phobics. In a second study, these phobic volunteers were shown to be similar on most measures to an outpatient clinically phobic sample. In an analysis of the combined samples, fearful and socially anxious subtypes were defined by questionnaires. Only the fearful subtype showed a significant covariation among physiological responses, imagery vividness, and severity of phobic disorder. This fearful-anxious distinction seems to cut across diagnostic categories, providing a heuristic perspective from which to view anxiety disorders.
Assuntos
Ansiedade , Medo , Imaginação , Transtornos Fóbicos/psicologia , Adulto , Ansiedade ao Tratamento Odontológico , Humanos , Masculino , FalaRESUMO
With the cochlear aqueducts blocked, guinea pig cochleas were perfused with artificial perilymph. The collected perfusates were treated with 5-(dimethylamino)-1-naphthalenesulfonyl chloride (dansyl-Cl). The derivatized constituents were analyzed by high- performance liquid chromatography using fluorometric detection. The concentration of none of the compounds measured, including the putative transmitters glutamate and aspartate, was found to increase in the perfusate in response to sound stimulation. These results do not support the suggestion that one of these compounds might be primary afferent transmitter of audition.
Assuntos
Aminoácidos/análise , Cóclea/fisiologia , Audição , Líquidos Labirínticos/análise , Neurotransmissores/fisiologia , Perilinfa/análise , Estimulação Acústica , Animais , Cobaias , Células Ciliadas Auditivas/fisiologiaRESUMO
As clinicians and scientists we see daily the close tie between parental competence and emotional functioning and how children succeed with many of life's stressors. Inadequate attention has been paid to the theoretical underpinnings of predicting children's emotional reactions to stress from a systems perspective. Longitudinal developmental studies of parental influence on children's ability to cope with life's frustrations, through reciprocal interactions and genetic predispositions, are mandatory. Theoretical frameworks are already developed which must be drawn on to derive the best predictions of when and how to involve our child patients with family support. The current essay will attempt to bridge family systems and social network theories to the understanding of children's coping with medical stressors.
Assuntos
Adaptação Psicológica , Relações Pais-Filho , Desenvolvimento da Personalidade , Papel do Doente , Criança , Comportamento Infantil , Humanos , Mães/educaçãoRESUMO
This study compared psychological dimensions of blood phobics and nonphobic controls, examined affect in response to phobic and neutral stimuli, and investigated the relationship between reported feelings of faintness and blood pressure. Blood phobics (24 adults with extreme Mutilation Questionnaire scores) and 24 nonphobics completed several psychological measures and viewed one of two 60 sec surgery scenes and a 60 sec neutral scene in counterbalanced order. Subjective, psychophysiologic, and motoric measures of affect were assessed. On questionnaires, phobics reported greater anxiety sensitivity, empathic distress, fear and insecurity, and nightmares, but no difference in autonomic arousal, muscle tension, motion sickness, or other empathy domains. During surgery scenes, phobics had more negative affect than controls; however, phobics were more anxious during only one of the two surgeries, and often only when the surgery was presented prior to the neutral scene. Fainting did not occur, and self-reported feelings of faintness were unrelated to blood pressure changes. The findings highlight the lack of information on blood phobic stimulus properties, fainting's relationship to self-reports and blood pressure, and the specific emotion experienced in blood phobia.
Assuntos
Nível de Alerta , Sangue , Dessensibilização Psicológica , Transtornos Fóbicos/psicologia , Adolescente , Adulto , Pressão Sanguínea , Feminino , Humanos , Masculino , Medição da Dor , Transtornos Fóbicos/terapia , Síncope/psicologiaRESUMO
In this study of the modification of anxiety-related disruptive behavior in dental treatment, matched groups of inner-city children attending a pedodontic clinic were shown a videotaped demonstration of a 4-year-old black child undergoing a dental restorative procedure or were given an unrelated drawing task before dental treatment. Children who viewed the videotape demonstration of a peer model coping with dental procedures showed significantly fewer fear-related disruptive behaviors during restoration of lesions. Observations of children's anxiety levels made by dentists and independent observers validated the effectiveness of viewing the videotaped demonstration. No significant correlation was found between the children's reports of their anxiety and their behavior during dental treatment.
Assuntos
Terapia Comportamental , Comportamento Infantil , Assistência Odontológica , Medo , Análise de Variância , Ansiedade , Criança , Pré-Escolar , Comportamento Cooperativo , Humanos , Odontopediatria , Grupo Associado , Gravação de VideoteipeRESUMO
Although the pain behavior of some diagnostic groups has been shown to be reactive to social influences, the reactivity of pain behavior in a rheumatoid arthritis (RA) population remains an open question. The authors in this article combined laboratory and self-report assessment techniques to examine the extent to which the pain report and behavior of 52 RA patients was susceptible to influence of social factors within the marital unit. The authors' findings suggest that (a) different types of spouse responsiveness (e.g., solicitous, punishing) may be viewed differently by the RA population than more general chronic pain populations; (b) the patient's perception of spouse responsiveness is a significant predictor of the pain behavior, whereas the spouse's perception of these same behaviors is not; and (c) the patient's perception of the spouse's responsive behavior adds significantly to the prediction of pain behavior over a model based on "disease impact" variables alone.
Assuntos
Artrite Reumatoide/complicações , Casamento/psicologia , Dor/etiologia , Satisfação Pessoal , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Research on modeling indicates that this technique offers dentists a means of reducing fear in child patients of all ages. As a preventive measure used with children who have had no prior exposure to dental treatment, it can be particularly efficacious. Based on the assumption that much of adult dental avoidance is based on dental fears acquired in childhood treatment, the reduction of children's dental fear would have a positive effect on the individual's tendency to seek out dental health care throughout his or her lifespan. For the dentist, there are also short- and long-term benefits. Dental management of the child is prerequisite to providing good dental care. Pedodontics as a specialty recognizes behavioral management of the child cannot be separated from the quality of the dentist's work. Fear has been identified as an important factor in disruptive behavior of school age children in the dental office. Practicing dentists consider the fearful, disruptive child to be among the most troublesome of problems in their clinical work. The child must cooperate or at least passively comply with the dentist's procedures in order to have the technical work completed. By reducing disruptive patient behavior (crying, screaming children whose peripheral and gross motor movements often make direct contact with the dentist or his equipment) the most unpalatable aspect of pediatric dentistry is minimized. Further, the actual time for treatment becomes shorter rather than longer. Although modeling is not restricted to videotape media, the emergence of current videotape technology provides the practitioner with the means for incorporating patient viewing of prerecorded modeling tapes as part of the usual waiting period. Such a procedure would mean that in the long run, the dentist will spend more time doing dentistry and less in behavioral management tasks.
Assuntos
Ansiedade/prevenção & controle , Terapia Comportamental/métodos , Comportamento Infantil , Assistência Odontológica/psicologia , Medo , Criança , Relações Dentista-Paciente , Humanos , Comportamento Imitativo , AprendizagemRESUMO
Clinical effectiveness of the double-blind administration of 1 and 2% lidocaine solutions was evaluated for restorative and surgical procedures on primary molars of children 4.5 to 10.5 years old. This effectiveness was measured by changes in the child's heart rate, the child's self report of pain, and the operator's assessment of the anesthesia's effectiveness. Although the incidence of anesthetic failure was higher for the 1% solution (31.3%) than for the 2% solution (11.1%), no statistically significant difference between the solutions was found. During the performance of pulpotomies and extractions, a higher failure rate was recorded for the 1% solution (62.5%) than for the 2% solution (28.6%), but these differences were not statistically significant. For minor restorative procedures, the 1% solution was equally successful in achieving anesthesia. The results suggested that 1% lidocaine should be used when multiple minor procedures are performed and potential toxicity in the young dental patient is a concern.
Assuntos
Dor Facial/prevenção & controle , Lidocaína/administração & dosagem , Anestesia Dentária , Anestesia Local , Criança , Método Duplo-Cego , Humanos , Dente Molar/cirurgia , Dente Decíduo/cirurgiaRESUMO
Physical contact with patients by health care providers has been found to benefit the patients by reducing their fearful or avoidant reactions. This study tested whether a reassuring touch could be used during a routine pediatric dental examination to reduce children's anxiety and improve their behavior. Thirty-eight children between 3.5 and 10 years of age were randomly assigned to one of two experimental conditions. Children assigned to the touch condition were patted on the upper arm or shoulder on two separate occasions by the dentist during the examination while simultaneously receiving verbal reassurance and descriptions of the upcoming procedures. Children in the no-touch control condition received only the reassuring verbal descriptions without contact. Results indicated that touched children between the ages of 7 and 10 years (but not children aged 3.5 to 7 years) displayed less fidgeting behavior than their no-touch counterparts (P < 0.05). Post-treatment, children who were touched tended to report greater pleasure (P < 0.06) but less dominance (P < 0.10) than children not touched.