Research Reports - Feedback learning and behavior problems after pediatric traumatic brain injury
Psychol Med. 2016 May;46(7):1473-84. doi: 10.1017/S0033291716000106. Epub 2016
Königs M(1), van Heurn LW(2), Vermeulen RJ(3), Goslings JC(4), Luitse JS(5),
Poll-Thé BT(6), Beelen A(7), van der Wees M(8), Kemps RJ(9), Catsman-Berrevoets
CE(10), Luman M(1), Oosterlaan J(1).
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