title: Feedback learning and behavior problems after pediatric traumatic brain injury.
abstract: BACKGROUND
  Feedback learning is essential for behavioral development. We investigated feedback learning in relation to behavior problems after pediatric traumatic brain injury (TBI).
  
  
  METHODS
  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.
authors.affiliation: Department of Clinical Neuropsychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Königs
authors.affiliation: Pediatric Surgical Center of Amsterdam,Emma Children's Hospital Academic Medical Center and VU University Medical Center,Amsterdam,The Netherlands.
authors.forename: L W E
authors.initials: LW
authors.lastname: van Heurn
authors.affiliation: Department of Pediatric Neurology,VU University Medical Center,Amsterdam,The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Vermeulen
authors.affiliation: Trauma Unit,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Emergency Medicine,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: J S K
authors.initials: JS
authors.lastname: Luitse
authors.affiliation: Department of Pediatric Neurology,Emma Children's Hospital Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: B T
authors.initials: BT
authors.lastname: Poll-Thé
authors.affiliation: Department of Rehabilitation,Academic Medical Center,Amsterdam,The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Beelen
authors.affiliation: Libra Rehabilitation Center 'Blixembosch',Eindhoven,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van der Wees
authors.affiliation: Libra Rehabilitation Center 'Leijpark',Tilburg,The Netherlands.
authors.forename: R J J K
authors.initials: RJ
authors.lastname: Kemps
authors.affiliation: Department of Pediatric Neurology,Erasmus Medical Center,Rotterdam,The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Catsman-Berrevoets
authors.affiliation: Department of Clinical Neuropsychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Luman
authors.affiliation: Department of Clinical Neuropsychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Oosterlaan
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000502:physiology*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002652:Child Behavior / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D030141:Feedback, Psychological / Q000502:physiology*; D005260:Female; D005793:Generalization, Psychological / Q000502:physiology*; D006801:Humans; D008297:Male; D000066553:Problem Behavior; D012720:Severity of Illness Index
keywords: Behavioral functioning; feedback learning; generalization of learning; pediatrics; traumatic brain injury