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Allen Cognitive Level Screen
(ACLS)
“a visuomotor task that provides an estimate of a person’s ability
to learn or do other visuomotor tasks”
“provides a quick estimate of a person’s current capacity to learn”
Allen, Earhart & Blue, 1992, p. 32
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Allen Cognitive Level Screen
(ACLS)
Intended Population
Adults with psychiatric disorders and adults with dementia, or
populations who demonstrate disruptive processing capacities.
A screen of functional cognition with persons whose cognitive
abilities appear to between 3.0-5.8 on the Allen scale
5. +
What does the ACLS observe?
Functional Cognition:
Motor/verbal skills, social behaviors, self awareness, and general
awareness
Focus intervention efforts on remaining capacities
Cognitive Disabilities Model:
Hypothesis-disruptions in cognition produce patterns of
attention/motor/verbal behavior that are observable in functional
tasks
Goal:
Observe a person’s cognitive abilities during 3 leather lacing tasks
of increasing complexity
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General Information
Features
Section I: History of the Cognitive Disabilities Model
Section II: Introduction to ACLS-5
Section III: Set-up of Leather-Lacing tools
Section IV: Preparation for Administration
Section V: Administration
Section VI: Assigning a Score
Section VIII: Review of Published Research
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Overall Recommendation
Communication tool between therapists and caregivers (level of
assistance)
Should be followed up w/ an appropriate assessment to confirm
functional cognitive capacity
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Studies
Reliability
Moderate-higher inter-rater reliability
Significant correlations supporting test-retest reliability
Validity
Significant relationship w/ FIM scores
Significant relationship w/ Symbol-Digit Modalities Test
(concentration)
Significant relationship w/ Wisconsin Card Sorting Test, Wechsler
Adult Intelligence Scale, Logical Memory Subtests I and II (working
memory)
Significant relationship w/ Hooper Visual Organization Test and Digit
Span Backward (higher-level cognitive processes)
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Case Study
Pt consistently demo’s impulsive decisions during therapy
activity—abruptly changing course of action. Pt is SBA with all
ADLs, and his family would like him to continue to live alone. Pt
also plans to live alone post d/c. Therapist suspects mild global
cognitive impairment (~Level 5.0)—decreased insight into safety
pc’s and poor judgment.
Therapist administers ACLS; pt receives screen score of 5.2
Follow up w/ additional assessment (ex. Allen Diagnostic Module)
OR document tentative nature of screen
Be clear w/ functional and safety implications of score
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Resources
Official website for ACLS and LACLS Committee:
www.allencognitivelevelscreen.org
Official website for Allen Cognitive Advisors, Ltd:
www.allen -cognitive-network.org
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References
Allen, C.K., Earhart, C.A., & Blue, T. (1992). Occupational therapy treatment
goals for the physically and cognitively disabled. Bethesda, MD: Occupational
Therapy Association.
Burns, McCarten, Adler, Bauer & Kuskowski, (2004). Effects of repetative work
on maintaining function in Alzheimer’s disease patients. American Journal of
Alzheimer’s Disease and Other Dementias, 19(1), 39-1.
David, S.K., & Riley, W.T. (1990). The relationship of the Allen Cognitive Level
Test to cognitive abilities and psychopathology. American Journal of
Occupational Therapy, 44(6), 493-497.
McCraith, D., & Henry, A. (2003). Usefulness of the cognitive disabilities model
in predicting community functioning among person with mental disorders.
Proceedings of the Symposium in Cognition, Tampa, Florida
Velligan, D.I, Bow-Thomas, C.C., Mahurin, R., Miller, A., Dassori, A., & Erdely,
F. (1998). Concurrent and predictive validity of the Allen Cognitive Levels
Assessment. Psychiatry Research.
The Allen Scale is an ordinal scale that reflects what persons pay attention to as observed in patterns of motor and speech performance
3.0=global cognition severely impaired; repetitive actions reflect awareness of material items but lack of awareness of cause/effect, end product, or goal
5.8: Difficulty learning a new activity; may need some assistance for planning for the future
Section 1: idea to measure global cognitive abilities was originated in the late 1960s by Claudia Allen; used craft projects to assess an individual’s cognitive level. Leather lacing preferred because of its portability and ease of use. This test continued to be revised—3 stitches added From Piaget’s 6 columns of sensorimotor to Allen’s 26modes of performance. This theory also incorporates clinical observation, especially in the various setting that people are in. Measures functional cognition—capacity of individuals with cognitive difficulties as they try to function in their daily lives.
Section II: Functional cognition is the central construct evaluated by the ACLs. This includes ability to learn something new, problem solve, follow directions and sequence, and recognize errors. The task demands span a range of abilities associated with cognitive levels 3, 4, 5. Describes the 3 stitches:
Running stitch—instruction consist of short statements with simple nouns and verbs accompanying demonstrations of this repeated action. No additional problems are introduced. Task demand theoretically matches with cognitive level 3.
Whipstitch is made by bringing a two-sided leather lace attached to a needle over the edge of the leather from front to back and pushing the needle in one dircetion through consecutive holes on the leather. Demonstrate first, then add two errors. Abilities theoretically associated with this stitch are Allen level 4: short term goals, using striking visible cues to compare and identify simple problems, and showing awareness of socially communicated standards.
Single cordovan stitch:This series requires close attention to the shifting spatial relationships between lace and leather and the ability to understand a complex visual cue. Self-dircted problem-solving is required when the administrator asks the person to complete the stitch without assistance. One verbal cue and up to two demonstrations of the stitch are provided as needed. Abilities: understanding complex visual cues, secondary effects of one’s actions, an solving problems with material objects by inductive or deductive reasoning
Intended population: developed for use with adults with
Consists of repeating the same action of pushing a threaded needle or lace through consecutive holes on leather. The instrucions consist of short statements with simple nouns and verbs accompanying demonstrations of repeated action. Theoretically associated with cognitive level 3 (attention focused on actions).
Bringing a two sided leather lace over the edge from front to back. Demo’d by instructor and requires attention to the striking visual properties. Ensures that person encounters two errors to correct, requests that person complete specific number of stitches
Theoretically associated with level 4: awareness of short term goals, using striking visible cues to compare and identify simple problems, and showing awareness of socially communicated standards—all of which are required to complete this task
Lengthy series of actions requires close attention to shifting spatial relationships between lace and leather and the ability to understand a complex visual cue. Self-directed problem-solving is required when the administrator asks the person to complete the stitch without assistance. Prompts of increasing specificity, including one verbal cue and up to two demonstrations of the stitch are provided as needed. Abilities to understand complex visual cues, secondary effects of one’s actions, and to solve problems with material objects by inductive or deductive reasoning are put to use in cimpletion of
Who may administer? Designed to be administered and scored by occupational therapists or other healthcare professional who have experience working with individuals with temporary or permanent cognitive impairments and who have been trained or mentored in the use of the cognitive disabilities model.
Again, that model is: he central construct of the Allen’s Model of Cognitive Disability considers both functional performance and global cognitive processing skills including attention, working memory, processing, organisation and problem solving. The model identifies levels of ability and the client’s capacity to perform routine tasks and adapt to novel situations.
Concerns/caution for interpretation: again, this is a screening. Not intended to diagnose.
Moderate-High inter-rater reliability
Significant correlations supporting test-retest reliability
**I have yet to find a study on internal reliability
5.2 on the Allen Scale indicates that person may be able to live alone w/ weekly checks to monitor safety and examine potentially dangerous effects of impulsive behavior. This would be a valid screen to communicate this w/ family.
