Allen's Cognitive Level Screen (ACLS)

Basic Information

• Title/Author(s):
  Assessment of Cognitive Levels Screening (ACLS-5 & LACLS-5)
  Developed by: Allen, C. K., Austin, S. L., David, S. K., Earhart, C. A., McCraith, D. B., & Riska-Williams, L.
  
  

• Edition and Year:
  5th Edition, 2007
  Published by the ACLS and LACLS Committee.
  
  

Assessment Details

• Types of Assessment:
  
  

  • Ipsative: Client performance is compared against their own abilities over time, not external norms.
    
    

  • Standardized: Follows specific administration and scoring procedures, though not considered the "gold standard" of standardized assessments.
    
    

• Cost & Accessibility:
  
  

  • Costs typically range between $100–$200 depending on the vendor and package.
    
    

  • Available for purchase from:
    
    

    • Therapro
      
      

    • ACLS & LACLS Committee Website
      
      

    • Amazon
      
      

  • Manual and materials sold separately or as bundles.
    
    

• Population & Setting:
  
  

  • Designed for adults with psychiatric conditions, dementia, neurological impairments, and cognitive dysfunction affecting daily life.
    
    

  • Suitable for settings including:
    
    

    • Inpatient psychiatry
      
      

    • Outpatient mental health
      
      

    • Skilled nursing facilities
      
      

    • Home health
      
      

    • Rehabilitation units
      
      

• Purpose & Areas Assessed:
  
  

  • Purpose:
    
    

    • To screen for functional cognitive abilities by observing how an individual processes information and solves problems during hands-on tasks.
      
      

    • Supports treatment planning based on Allen Cognitive Levels.
      
      

  • Areas Assessed:
    
    

    • Problem-solving ability
      
      

    • New learning potential
      
      

    • Safety awareness
      
      

    • Functional cognition related to task performance
      
      

Administration & Scoring

• Administration:
  
  

  • Time Required: Approximately 20–30 minutes.
    
    

  • Format:
    
    

    • Administered individually using a series of standardized leather-lacing tasks.
      
      

  • Instructions:
    
    

    • Client completes three progressively complex stitches:
      
      

      1. Running Stitch
         
         

      2. Whipstitch
         
         

      3. Single Cordovan Stitch
         
         

• User Qualifications:
  
  

  • Should be administered by licensed occupational therapists or trained healthcare professionals familiar with the Allen Cognitive Disabilities Model.
    
    

  • Interpretation requires formal training or practice to ensure scoring accuracy.
    
    

• Materials Required:
  
  

  • Pre-punched leather rectangle (4” x 5”)
    
    

  • Large blunt sewing needle
    
    

  • Two brass locking needles
    
    

  • Leather lace and waxed linen thread
    
    

• Scoring:
  
  

  • The ACLS assigns a cognitive level score between 3.0 and 5.8.
    
    

  • Scoring is based on the client's ability to replicate and correct stitching patterns with minimal or no cues.
    
    

  • Higher cognitive levels reflect greater independence, problem-solving ability, and learning capacity.
    
    

  • Results guide recommendations for safe functional participation and support needs.
    
    

Psychometrics/Standardization

• Reliability:
  
  

  • Demonstrates high interrater reliability when administered by trained evaluators (Velligan et al., 1997).
    
    

  • Consistency improves with calibration training.
    
    

• Validity:
  
  

  • Shows moderate to strong concurrent validity with broader measures of executive function and real-world functioning (Allen et al., 2007).
    
    

• Norms:
  
  

  • Not norm-referenced.
    
    

  • Based on Allen Cognitive Level Framework, focusing on task-based observations rather than population norms.
    
    

Critical Thinking Sections

Strengths

• Quick screening — Can be administered in a short clinical appointment.
  
  

• Highly ecological — Observes real-life problem-solving, linking cognition to everyday activities.
  
  

• Widely used in OT — Recognized across psychiatric, geriatric, and neurological rehabilitation settings.
  
  

• Standardized scoring — Allows structured comparison across sessions for the same individual.
  
  

Weaknesses

• Limited cognitive range — Only assesses mid-range cognitive abilities (Levels 3.0–5.8).
  
  

• Requires specific materials — Leather, laces, and specialized needles needed; may not always be readily available.
  
  

• Cultural/experiential biases — Clients unfamiliar with sewing or lacing tasks may underperform.
  
  

• Not a comprehensive cognitive assessment — Best used as part of a broader functional evaluation.
  
  

References

Allen, C. K., Austin, S. L., David, S. K., Earhart, C. A., McCraith, D. B., & Riska-Williams, L. (2007). Manual for the Allen Cognitive Level Screen-5 (ACLS-5) and Large Allen Cognitive Level Screen-5 (LACLS-5). ACLS & LACLS Committee.

Katz, N. (2006). Cognition, occupation, and participation across the lifespan: Neuroscience, neurorehabilitation, and models of intervention in occupational therapy. AOTA Press.