Behavior Guidance and Child Psychology
What the exam tests
Behavior guidance questions test whether you can match a technique to the child's developmental stage, obtain and document consent, and respect the boundaries set by AAPD guidance and child-protection law.
Core rules
- Frankl scale: 1 definitely negative, 2 negative, 3 positive, 4 definitely positive.
- Tell-show-do is first-line. Voice control is used to gain attention, never to humiliate. Positive reinforcement and distraction are non-aversive.
- Piaget: preoperational (2-7 years) is egocentric and magical, so use simple words and one instruction at a time; concrete operational (7-11) understands cause and effect; formal operational (12+) can reason abstractly.
- Separation anxiety peaks around 8-18 months; stranger anxiety around 6-9 months.
- Protective stabilization requires informed consent, is a last resort, is contraindicated with a history of physical or sexual abuse, and must document reason and duration.
- Nitrous oxide 30-50% with at least 30% oxygen; contraindicated in nasal obstruction, recent otitis media, B12 deficiency, pregnancy and severe COPD.
Worked example
A 4-year-old screams and refuses the chair; the parent asks to stay. Reasoning: at 4 the child is preoperational and highly suggestible. Start with tell-show-do and a brief parent-out-of-sight trial; allow the parent in if it calms the child; consider nitrous oxide only after these steps. Physically holding the child without consent is not acceptable.
Traps
Labelling a Frankl 2 child uncooperative without a plan; using voice control sarcastically; assuming parental presence always helps; forgetting that nitrous oxide needs a patent nose and scavenging.