Revisiting Piaget's Cognitive Principles among 4–7-year-old Children in the Kashmiri Population

ABSTRACT

Background

Jean Piaget posits that children aged 4–7 years are in the intuitive substage of the preoperational stage, which is marked by distinct cognitive characteristics typical of this developmental period. However, these unique cognitive characteristics have not been extensively explored in the context of dentistry.

Aim

To evaluate the relevance and applicability of Piaget's cognitive principles in preoperational-stage children within the Kashmiri population.

Materials and methods

The study included 88 children, divided into four groups: 4-year-olds, 5-year-olds, 6-year-olds, and 7-year-olds. Three tangible experiments were conducted to assess egocentrism, centration, and the lack of conservation and reversibility, based on Piaget's theory of cognitive development. Additionally, two questions were asked to each child. Prior to the study, all participants were familiarized with the pediatric dental clinic. The collected data were organized in Microsoft Excel and analyzed using SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA). Statistical comparisons between the age-groups were conducted using the Chi-square test, with significance set at a p-value < 0.05.

Results

The prevalence of egocentrism varied across different experiments: 38.6% in the three mountains experiment, 62.5% in personal interviews, and 19.3% in the superhero experiment. Centration was observed in 46.6% of the study participants. The beaker experiment revealed that 73.9% of the children lacked conservation. Overall, there was a gradual decrease in the prevalence of these characteristics with increasing age.

Conclusion

In most children aged 4–7 years, all three Piagetian features were observed, indicating that many of Piaget's developmental principles are still relevant. This suggests that his theories on cognitive development continue to hold true for the Kashmiri population, underscoring the lasting applicability of his concepts in this context.

How to cite this article

Shabnam M, Lone N, Sidiq M. Revisiting Piaget's Cognitive Principles among 4–7-year-old Children in the Kashmiri Population. Int J Clin Pediatr Dent 2025;18(7):766–771.

INTRODUCTION

The “cognitive revolution” in psychology, which emerged during the 1960s, marked a significant departure from behaviorism by redirecting attention toward the essential role of mental processes in information acquisition, language development, thinking, and problem-solving.¹ Among the most influential contributors to this movement was Jean Piaget, a Swiss psychologist (1896–1980), who developed a foundational theory of cognitive development. Piaget referred to himself as a “genetic epistemologist,” emphasizing his focus on understanding the origins and development of human knowledge and cognition.² He suggested that children progress through a series of clearly defined phases in mental growth, each characterized by its own distinct set of intellectual strengths and weaknesses.³ The second phase of Piaget's model, termed the preoperational stage, typically spans from age 2 to 7 years. This phase is further categorized into two substages: the preconceptual stage (2–4 years) and the intuitive stage (4–7 years). During the preoperational period, children begin to engage in symbolic thinking, but their reasoning is often dominated by perceptual features rather than logical operations, leading to what Piaget described as “prelogical reasoning.”³

While working at Binet's intelligence testing laboratory in Paris, Piaget observed notable qualitative differences in how younger and older children responded to the same questions. He attributed these differences to variations in cognitive processes rather than disparities in intelligence.⁴ These observations led him to conclude that children's responses were not determined by intelligence quotient (IQ), but rather by their stage of cognitive development. At each developmental stage, children construct an understanding of the world that is appropriate to their cognitive abilities at that age. As they progress to subsequent stages, they must retain the mental flexibility to reconstruct earlier concepts within more advanced cognitive frameworks. Piaget ultimately proposed that intellectual development follows an upward spiral, wherein children continuously reorganize and refine prior knowledge as they acquire more complex cognitive structures.^5–7

Piaget's theory was primarily based on detailed observations of Western children, including his own children, and may not fully reflect cognitive development trajectories in diverse cultural settings. This study aimed to determine whether Piaget's characteristic features of cognitive development are applicable to children in the Kashmiri population and to assess the potential application of these development-based principles in examining learning processes within a dental practice. Kashmir, with its distinct sociocultural context and prolonged exposure to conflict, provides a compelling setting to explore both the universality and cultural variability of Piaget's developmental stages.

However, there is a lack of empirical data on cognitive development principles among children aged 4–7 years within the Kashmiri population, highlighting the necessity for comprehensive research in this area. Therefore, this study aimed to evaluate the extent to which Piaget's cognitive principles apply to Kashmiri children aged 4–7 years and to explore their potential implications in pediatric dental practice. Such information is crucial for enhancing the standard and effectiveness of pediatric dental care in the region.

MATERIALS AND METHODS

This observational study was conducted in the Department of Pediatric and Preventive Dentistry following ethical clearance from the Institutional Review Board and the Institutional Ethics Committee. Before initiating the study, detailed information sheets explaining the purpose and procedures were given to the parents or guardians. Written consent was obtained for the participation of their children.

Determination of Sample Size

The required sample size was estimated using the G*Power software (version 3.0.10; Franz Faul, Kiel University, Kiel, Germany). The calculation of sample size was based on the following formula:

$$\mathit{\text{Sample size}}=\frac{Z^{2}p(1-p)}{e^2}$$

where Z is the Z-score corresponding to the desired confidence level, p is the estimated prevalence, and e is the margin of error. Based on this formula, with a 5% level of significance, an estimated prevalence (p) of 65% (0.65), and a 10% margin of error (e), the required sample size was determined to be 88.

A total of 88 healthy children aged 4–7 years were included in the study. They were evenly divided into four age-specific groups:

Group I: 4-year-old.

Group II: 5-year-old.

Group III: 6-year-old.

Group IV: 7-year-old.

All children included in the study were of Kashmiri origin and belonged to similar socioeconomic backgrounds. Information regarding each child's age, socioeconomic status, and ethnicity was obtained through parental reports. Children with special healthcare needs, as well as those whose parents declined to provide consent for participation, were excluded from the study.

Three tasks were conducted to evaluate the classical cognitive characteristics in children, specifically:

1. Egocentrism.

2. Understanding of cardinal numbers.

3. Lack of conservation and reversibility.

All children completed these tasks and responded to two interview questions in a face-to-face setting. These assessments were based on Piaget's theory of cognitive development.

Egocentrism

Egocentrism refers to a child's inability to consider or understand another person's perspective or point of view. It does not imply that the child is self-centered; rather, it indicates a developmental limitation in appreciating viewpoints different from their own.

In this study, egocentrism was evaluated using the classical Three Mountains Task (Fig. 1). The child was seated on one side of a table, with a doll placed on the opposite side, and three mountains of varying heights arranged between them. The child was shown a series of photographs and asked to select the image that best represented the doll's viewpoint. A child demonstrating egocentrism typically chooses the photograph corresponding to their own perspective, rather than that of the doll, indicating difficulty in understanding perspectives other than their own.⁸

Fig. 1:

The three mountains experiment designed to investigate the cognitive development of children with respect to egocentrism in children's thinking

An interview question was designed to assess egocentrism within a dental context. The child was first shown a set of pictures depicting various gifts and asked to select one they would like to receive after dental treatment. Subsequently, the child was asked to choose a gift for a friend from the same set. If the child selected the same gift for both themselves and their friend, this was interpreted as an indication of egocentrism.

Additionally, to evaluate perceptual egocentrism, a “superhero” task was conducted. The child sat across a table on which two superhero toys were placed. Initially, the child was asked whether they could see both toys, to which the expected response was affirmative. Next, an obstruction was introduced between the two toys in such a way that the child could still see both. The child was then asked again if they could see both superheroes, and after confirming, was asked whether the two superheroes could see each other. A positive response indicated the presence of perceptual egocentrism, reflecting difficulty in understanding perspectives other than their own.

Understanding of Cardinal Numbers

The coin task was designed using the idea of centration, which refers to a child's tendency to concentrate on one aspect of a scenario while neglecting others (Fig. 2). In this activity, the child was shown two rows with equal numbers of coins and asked if both rows contained the same quantity. Once the second row was spaced out, the same question was posed again. A child showing centration typically believes that the dispersed row has more coins, whereas a child who grasps cardinality correctly identifies that both rows still hold the same quantity.

Fig. 2:

The coin experiment illustrates children's understanding of cardinal numbers

Lack of Conservation and Reversibility

The concept of conservation explains that two amounts of a substance remain equal even if their appearance is altered, provided that no material is added or taken away. To test this idea, a classic beaker experiment was carried out (Fig. 3). In the experiment, a child was shown two beakers containing the same volume of colored liquid. After transferring the liquid from one beaker into a taller, narrower one, the child was asked which beaker contained more liquid. If the child chose the taller one, it indicated a misunderstanding of the conservation principle.⁸

Fig. 3:

The classical beaker experiment highlights the developmental stages in children's reasoning

To explore this understanding in a dental context, children were shown an illustration featuring a healthy, smiling tooth that became decayed and unhappy after eating chocolates and toffees. The child was then asked what could be done to keep the tooth healthy and smiling (Fig. 4). If the child pointed to toffees as the cause of the damage, it showed that the child grasped the concepts of conservation and reversibility.

Fig. 4:

Interview question used to assess candidates across different competencies

Statistical Analysis

The data obtained were initially organized using a Microsoft Excel spreadsheet and subsequently imported into SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA) for in-depth statistical evaluation. Categorical data were summarized using frequencies and percentages, while continuous variables were presented as mean ± standard deviation (mean ± SD). To assess differences in categorical variables among age-groups, the Chi-square test was applied. A p-value below 0.05 was regarded as statistically significant.

RESULTS

In the present study, a total of 88 children aged 4–7 years were assessed to compare the prevalence of three cognitive characteristics: egocentrism, centration, and lack of conservation. The presence or absence of each characteristic was expressed as a percentage. The prevalence of egocentrism varied depending on the method used: 38.6% of the children demonstrated egocentrism through the three mountains experiment, 62.5% through a face-to-face interview, and 19.3% through the superhero experiment (Table 1). Centration was observed in 46.6% of the study sample (Table 2). Additionally, a significant 73.9% of the children displayed a lack of conservation when tested with the beaker experiment (Table 3). This study also included a comparative analysis of these cognitive characteristics across different age-groups, which is illustrated in Figures 5 to 7.

Table 1:

Prevalence of egocentrism across different age-groups, based on three mountains experiment, interview question, and superhero experiment

Age-group	Mountain experiment		Interview question		Superhero experiment
	No.	%	No.	%	No.	%
4 years	19	86.4	21	95.5	13	59.1
5 years	12	54.5	17	77.3	2	9.1
6 years	2	9.1	11	50.0	2	9.1
7 years	1	4.5	6	27.3	0	0.0
Total	34	38.6	55	62.5	17	19.3
p-value	<0.001*		<0.001*		<0.001*

^*Statistically significant difference (p-value < 0.05)

Table 2:

Prevalence of centration across different age-groups based on the coin experiment

Age-group	N	Prevalence		p-value
		No.	%
4 years	22	20	90.9	<0.001*
5 years	22	14	63.6
6 years	22	4	18.2
7 years	22	3	13.6
Total	88	41	46.6

^*Statistically significant difference (p-value < 0.05)

Table 3:

Prevalence of lack of conservation based on the beaker experiment among different age-groups

Age-group	N	Prevalence		p-value
		No.	%
4 years	22	22	100	<0.001*
5 years	22	20	90.9
6 years	22	13	59.1
7 years	22	10	45.5
Total	88	65	73.9

^*Statistically significant difference (p-value < 0.05)

Fig. 5:

Prevalence percentage of egocentrism based on the three mountains experiment, interview question, and superhero experiment among different age-groups

Fig. 7:

Prevalence percentage of lack of conservation based on the beaker experiment and interview question among different age-groups

Fig. 6:

Prevalence percentage of centration based on the coin experiment among different age-groups

DISCUSSION

Piaget viewed the child as a mini-scientist, driven by curiosity to explore their surroundings. Piaget categorized children's development into distinct stages based on his theory that all children progress through the same stages in a fixed sequence. The second stage, known as the preoperational period, is characterized by children's symbolic thinking about objects, although their reasoning tends to be guided more by appearances than by logical processes.⁶ This stage is divided into the preconceptual (ages 2–4) and intuitive (ages 4–7) stages. During the intuitive stage, children begin to develop more complex images and concepts, leading to prelogical reasoning.^1,5 In the present study, we included children aged 4 years and older—who are often the most challenging to manage in a dental setting—while excluding those younger than 4 years, as they generally lack the cognitive ability required to comprehend the study tasks. So, this study was conducted to revisit Piaget's foundational cognitive principles by examining their applicability to a specific demographic 4–7-year-old children in the Kashmiri population, a culturally distinct group.

Our study's findings revealed a significantly higher prevalence of cognitive egocentrism among Kashmiri children in the 4–5-year age-group, with a notable decrease from 86 to 4.5% in the mountain experiment as children aged from 4 to 7 years. Similarly, in the interview question task, which evaluated the child's ability to understand that others may hold different beliefs or knowledge, the prevalence of egocentrism dropped from 95.5 to 27.3%. This inverse relationship between egocentrism and age implies that the children at this stage struggle to adopt another person's viewpoint and assume that others see and experience the world as they do. These findings support Piaget's observations and suggest that egocentrism is common in the early preoperational stage but diminishes as children approach school age and begin to recognize others' viewpoints. Borke⁹ replicated Piaget's Three Mountains Task using more familiar and less abstract stimuli and found similar age-related declines in egocentric responses. Similarly, Newcombe and Huttenlocher¹⁰ observed that as children mature, they become more adept at spatial perspective-taking, a skill closely related to overcoming egocentrism.

In our study, perceptual egocentrism also showed a decline with age, as demonstrated in the superhero experiment, where the egocentrism prevalence dropped from 59.1 to 0%. This finding is consistent with Piaget's theory, which posits that as children's cognitive development progresses, they gradually overcome egocentrism and begin to recognize that others may hold different perspectives, beliefs, and knowledge. Wimmer and Perner¹¹ supported this finding by showing that children's understanding of false beliefs, closely related to overcoming egocentrism, improves with age and social experience.

The concepts of conservation, reversibility, and understanding cardinal numbers are fundamentally rooted in the principle of centration, where a child concentrates on a single feature of a scenario while neglecting other important elements. In our study, the coin experiment revealed that 90.9% of 4-year-old children and 13.6% of 7-year-olds demonstrated a lack of conservation, indicating that younger children had greater difficulty understanding this concept, with similar trends in understanding the connection between teeth, chocolates, and dental decay. Notably, some children with prior dental experience remarked that a tooth would not return to its normal state unless it was “filled” or “painted with cement” to make it healthy and happy again. This finding suggests that children's responses are influenced by their experiences and understanding of the questions posed. Beilin¹² provides evidence that younger children often struggle with understanding that certain physical properties remain constant despite changes in appearance, a concept that becomes more graspable as they age, aligning with Piaget's findings.

Additionally, our findings also showed that the lack of conservation was most common among 4-year-olds in the beaker experiment (100%), decreasing to 45.5% among 7-year-olds. Children aged 4–7 years demonstrated difficulty in simultaneously considering both the width and height of the liquid within a container. This observation aligns with Piaget's principle that younger children (typically aged 2–7 years) are often influenced by the most visually striking feature of a situation. They tend to focus on a single prominent attribute at a time, which limits their ability to solve problems that require consideration of multiple aspects.⁸ During treatment, this can lead to fear when faced with multiple instruments. To address this, the child should be guided to concentrate on a single object, such as a hand mirror, and focus on observing the procedure.^2,13 The results of our study are consistent with those reported by Chandrashekhar et al.,¹⁴ who observed that children's understanding of conservation varies significantly with age and is influenced by both cognitive development and environmental factors. Miller and Coyle¹⁵ reported that children's judgments about quantities change with age, focusing on the role of perceptual and cognitive factors. It provides additional evidence that conservation abilities improve as children grow older, which is consistent with the age-related decline in egocentrism and lack of conservation.

In practical settings, particularly in pediatric dentistry, the findings suggest that understanding a child's cognitive development is crucial for effective communication and treatment. For instance, informing a child that their parents would be proud if they stopped thumb-sucking may be ineffective due to cognitive egocentrism, which limits their ability to consider others' perspectives.⁸ Similarly, children's understanding of concepts, such as pain and local anesthesia is age-dependent, necessitating communication and management strategies tailored to their cognitive level. Effective approaches may include the use of local anesthesia to reduce discomfort and involving the child in simple decision-making during treatment to foster cooperation and engagement. Distraction techniques, such as audiovisual aids or headphones with calming music, are effective in reducing anxiety by working with the child's tendency toward centration. By focusing on less intimidating aspects of their environment, children can shift their attention away from distressing stimuli, making the dental experience more manageable.

In contrast, research by Perner et al.¹⁶ suggested that children might develop a rudimentary theory of mind earlier than Piaget predicted, indicating that cognitive egocentrism may diminish earlier depending on the child's environment and interactions. Gelman and Baillargeon¹⁷ suggested that children's understanding of conservation might be more context-dependent, with some children demonstrating an understanding of conservation under specific conditions earlier than Piaget theorized. This indicates that while centration and lack of conservation are prevalent among young children, the development of these abilities may be influenced by the complexity of the task and the child's prior experiences.

Our study's findings suggest that Piaget's theories are broadly applicable, extending beyond Western contexts to encompass diverse cultural settings, such as the Kashmiri population. This supports the universality of Piaget's cognitive stages, although the variations observed in some cases highlight the importance of considering cultural and contextual factors in cognitive development. Further research could explore these cultural influences in greater detail, particularly how social interactions and educational practices in different cultures might impact the progression through Piaget's stages.

CONCLUSION

This observational study offers valuable insights into the applicability of Piaget's developmental characteristics in 4–7-year-old children from the Kashmiri population. The study highlights a trend where developmental characteristics related to egocentrism and centration diminish with age, reflecting an evolution in cognitive abilities as children mature. These insights are valuable for tailoring educational and pediatric practices to better align with children's cognitive stages, especially in culturally diverse settings. By extending Piaget's work to a non-Western population, the study contributes to a more comprehensive and culturally nuanced understanding of cognitive development, suggesting that while Piaget's stages are broadly applicable, they must be contextualized within the specific cultural and environmental backgrounds of the children being studied. This cognitive development provides a valuable framework, but further studies should be done on individual and cultural variations that can influence the rate and manner in which these cognitive abilities develop.

ORCID

Murtaza Shabnam https://orcid.org/0009-0004-5905-3251