European Archives of Paediatric Dentistry (2018) 19:171–175
ORIGINAL SCIENTIFIC ARTICLE
Reliability and validity of a newly proposed classiﬁcation system
for categorisation of parental behaviour (CCPB) in the dental setting
· Rahul Kaul
· Subrata Saha
Received: 16 July 2017 / Accepted: 16 April 2018 / Published online: 15 May 2018
© European Academy of Paediatric Dentistry 2018
Aim To evaluate the reliability and validity of a newly proposed classiﬁcation system for categorisation of parental behaviour
(CCPB) in the dental setting.
Methods Parents of patients aged 5–14 years were included. 127 parents were evaluated and rated on two scales: Parental
Cooperation Scale (PCS; 1–4) and CCPB (0–5) by two trained examiners during the initial interaction of the parent with the
examiners at their ﬁrst visit in the dental setting. Kappa Score measurement of agreement was used to assess the inter-rater
reliability. Spearman’s rho correlation was used to assess the correlations between PCS and CCPB.
Results The Kappa score between independent raters was 0.774 (substantial agreement) and Spearman’s rho correlation
coeﬃcient was 0.778, which was statistically signiﬁcant (p < 0.001).
Conclusions The CCPB refers to the same domain as the PCS and was found to be a reliable tool to be used in future research.
Keywords Classiﬁcation · Behaviour rating scale · Relation · Parent-dentist
The concept of treatment has broadened from an individu-
alistic disease-based approach to a more holistic approach.
The same has been projected into the ﬁeld of paediatric
dentistry. Treatment now involves guiding the child and the
parent through the dental experiences, taking into considera-
tion the expectations of the parents and the norms of society.
This expanded and inter-dependent relationship has been
well illustrated in the modiﬁed 2013 paediatric dentistry
treatment triangle (Wright and Kupietzky 2014).
One increasingly important but comparatively less inves-
tigated aspect of the paediatric treatment triangle is the
dentist and the parent/caregiver relationship (Bailey et al.
1973; Chambers et al. 2002; Valiente et al. 2004; Kyristi
et al. 2009; McMurtry et al. 2010; Themessl-Huber et al.
2010; Coric et al. 2014).
As per the intersubjectivity theory, introduced by Robert
Stolorow and George Atwood (1997), assessing and rating
parental behaviour can place the dentist in a better frame of
mind to respond, instead of reacting and in eﬀectively gain
a child’s and parent’s trust and support required. Parental
behaviour rating scale/classiﬁcation systems also aid in pro-
fessional communication and in research studies (McCo-
naughy and Ritter 2002).
Kupietzky et al. (2013) introduced and validated a Parent
Cooperation Scale (PCS) to categorise parent behaviours
and assess a parent’s ability to be a constructive and support-
ing inﬂuence on a child during their dental treatment. The
PCS is analogous to the Frankl scale (Frankl et al. 1962) for
rating child behaviours, with four groups of parent behav-
iours: deﬁnitely negative (refusal of treatment plan, suspi-
cious of dentist, overprotective of child), negative (reluc-
tance to accept complete treatment plan, some evidence of
negative attitude, acts as liaison between patient and dentist),
positive (acceptance of treatment plan, cautious behaviour at
times, reluctantly allows child to be alone with the dentist),
deﬁnitely positive (trustful, expresses conﬁdence in dentist,
allows patient to be alone with dental staﬀ).
The psychodynamic theories of personality (Bienenfeld
2006) and the behaviour learning theories (Ormrod 2008) in
psychology have tried to explain the development of com-
plex emotions and the change in the manner of expression
as a person matures. Parental behaviour is generally more
* Parul Jain
Department of Paedodontics and Preventive Dentistry, Dr. R.
Ahmed Dental College and Hospital, 114 AJC Bose Road,
Kolkata, West Bengal 700014, India