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Feedback learning and behavior problems after pediatric traumatic brain injury

Published online by Cambridge University Press:  08 March 2016

M. Königs ,
L. W. E. van Heurn ,
R. J. Vermeulen ,
J. C. Goslings ,
J. S. K. Luitse ,
B. T. Poll-Thé ,
A. Beelen ,
M. van der Wees ,
R. J. J. K. Kemps  and
C. E. Catsman-Berrevoets
...Show all authors
M. Königs*
Affiliation:
Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
L. W. E. van Heurn
Affiliation:
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center and VU University Medical Center, Amsterdam, The Netherlands
R. J. Vermeulen
Affiliation:
Department of Pediatric Neurology, VU University Medical Center, Amsterdam, The Netherlands
J. C. Goslings
Affiliation:
Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
J. S. K. Luitse
Affiliation:
Department of Emergency Medicine, Academic Medical Center, Amsterdam, The Netherlands
B. T. Poll-Thé
Affiliation:
Department of Pediatric Neurology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
A. Beelen
Affiliation:
Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands Merem Rehabilitation Center ‘De Trappenberg’, Huizen, The Netherlands
M. van der Wees
Affiliation:
Libra Rehabilitation Center ‘Blixembosch’, Eindhoven, The Netherlands
R. J. J. K. Kemps
Affiliation:
Libra Rehabilitation Center ‘Leijpark’, Tilburg, The Netherlands
C. E. Catsman-Berrevoets
Affiliation:
Department of Pediatric Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
M. Luman
Affiliation:
Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands Department of Methods, VU University Amsterdam, Amsterdam, The Netherlands
J. Oosterlaan
Affiliation:
Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
*
*Address for correspondence: M. Königs, M.Sc., Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: m.konigs@vu.nl)
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Abstract

Background

Feedback learning is essential for behavioral development. We investigated feedback learning in relation to behavior problems after pediatric traumatic brain injury (TBI).

Method

Children aged 6–13 years diagnosed with TBI (n = 112; 1.7 years post-injury) were compared with children with traumatic control (TC) injury (n = 52). TBI severity was defined as mild TBI without risk factors for complicated TBI (mildRF− TBI, n = 24), mild TBI with ⩾1 risk factor for complicated TBI (mildRF+ TBI, n = 51) and moderate/severe TBI (n = 37). The Probabilistic Learning Test was used to measure feedback learning, assessing the effects of inconsistent feedback on learning and generalization of learning from the learning context to novel contexts. The relation between feedback learning and behavioral functioning rated by parents and teachers was explored.

Results

No evidence was found for an effect of TBI on learning from inconsistent feedback, while the moderate/severe TBI group showed impaired generalization of learning from the learning context to novel contexts (p = 0.03, d = −0.51). Furthermore, the mildRF+ TBI and moderate/severe TBI groups had higher parent and teacher ratings of internalizing problems (p's ⩽ 0.04, d's ⩾ 0.47) than the TC group, while the moderate/severe TBI group also had higher parent ratings of externalizing problems (p = 0.006, d = 0.58). Importantly, poorer generalization of learning predicted higher parent ratings of externalizing problems in children with TBI (p = 0.03, β = −0.21) and had diagnostic utility for the identification of children with TBI and clinically significant externalizing behavior problems (area under the curve = 0.77, p = 0.001).

Conclusions

Moderate/severe pediatric TBI has a negative impact on generalization of learning, which may contribute to post-injury externalizing problems.

Keywords

Behavioral functioningfeedback learninggeneralization of learningpediatricstraumatic brain injury
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 7 , May 2016 , pp. 1473 - 1484
Copyright
Copyright © Cambridge University Press 2016 

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