title: Functional analysis-based interventions for challenging behaviour in dementia.
abstract: BACKGROUND
  Functional analysis (FA) for the management of challenging behaviour is a promising behavioural intervention that involves exploring the meaning or purpose of an individual's behaviour. It extends the 'ABC' approach of behavioural analysis, to overcome the restriction of having to derive a single explanatory hypothesis for the person's behaviour. It is seen as a first line alternative to traditional pharmacological management for agitation and aggression. FA typically requires the therapist to develop and evaluate hypotheses-driven strategies that aid family and staff caregivers to reduce or resolve a person's distress and its associated behavioural manifestations.
  
  
  OBJECTIVE
  To assess the effects of functional analysis-based interventions for people with dementia (and their caregivers) living in their own home or in other settings.
  
  
  METHODS
  We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 3 March 2011 using the terms: FA, behaviour (intervention, management, modification), BPSD, psychosocial and Dementia.
  
  
  METHODS
  Randomised controlled trials (RCTs) with reported behavioural outcomes that could be associated with functional analysis for the management of challenging behaviour in dementia.
  
  
  METHODS
  Four reviewers selected trials for inclusion. Two reviewers worked independently to extract data and assess trial quality, including bias. Meta-analyses for reported incidence, frequency, severity of care recipient challenging behaviour and mood (primary outcomes) and caregiver reaction, burden and mood were performed. Details of adverse effects were noted.
  
  
  RESULTS
  Eighteen trials are included in the review. The majority were in family care settings. For fourteen studies, FA was just one aspect of a broad multi-component programme of care. Assessing the effect of FA was compromised by ill-defined protocols for the duration of component parts of these programmes (i.e. frequency of the intervention or actual time spent). Therefore, establishing the real effect of the FA component was not possible.Overall, positive effects were noted at post-intervention for the frequency of reported challenging behaviour (but not for incidence or severity) and for caregiver reaction (but not burden or depression). These effects were not seen at follow-up.
  
  
  CONCLUSIONS
  The delivery of FA has been incorporated within wide ranging multi-component programmes and study designs have varied according to setting - i.e. family care, care homes and hospital, with surprisingly few studies located in care homes. Our findings suggest potential beneficial effects of multi-component interventions, which utilise FA. Whilst functional analysis for challenging behaviour in dementia care shows promise, it is too early to draw conclusions about its efficacy.
authors.affiliation: Clinical Psychology & Ageing, Institute of Rehabilitation,University of Hull, Hull,UK. E.D.Moniz-Cook@hull.ac.uk
authors.forename: Esme D
authors.initials: ED
authors.lastname: Moniz Cook
authors.forename: Katie
authors.initials: K
authors.lastname: Swift
authors.forename: Ian
authors.initials: I
authors.lastname: James
authors.forename: Reem
authors.initials: R
authors.lastname: Malouf
authors.forename: Marjolein
authors.initials: M
authors.lastname: De Vugt
authors.forename: Frans
authors.initials: F
authors.lastname: Verhey
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D017028:Caregivers / Q000193:education* / Q000523:psychology; D003216:Conditioning, Operant / Q000502:physiology; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000628:therapy; D006801:Humans; D009042:Motivation / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000628:therapy