The Allen Cognitive Disability Model (ACDM) looks at facilitating the person's best ability to function by modifying or create new activities that they can participate in and making adjustments for individual differences to eliminate barriers. Before you can use the ACDM, an understanding of the Allen Cognitive Levels (ACLs) is required.
What are the Allen Cognitive Levels?
The ACLs look at how the brain works as a whole unit. These patterns of performance were observed by Claudia Allen since the late 1960's. They became the Allen Cognitive Levels. Six distinct levels were first observed and later five modes were added to each level. This resulted in the scores ACL 1.0, 1.2, 1.4, 1.6, 1.8, 2.0, 2.2, …… 5.6, 5.8, 6.0. This gives a total of 27 modes.
The ACLs cover a functional range from coming out of a comma through to normal adult ability to function. The person pays attention to the following types of information:
- ACL 1: Sensory information is used for sensing strong sensory cues, choosing between different sensory information and tracking sensory sources.
- ACL 2: Movement information is used to choose between different postures, standing and walking.
- ACL 3: Linear information is used for manual actions and placing objects in different linear relationships.
- ACL 4: Classification information is used for grouping two or three actions by matching striking features in order to form a concept of an activity.
- ACL 5: Inventive information uses surface and spatial properties and their effects for solving a problem in the physical environment.
- ACL 6: Abstract information uses ideas and thinking in hypothetical scenarios.
The scale is hierarchical and additive.
"Once a type of information starts to be used, it continues to be used in more complex forms." Claudia Allen 2015
The use of numbers can be deceptive as this is an ordinal scale and the intervals are not evenly spaced but are in a set order.
Allen Cognitive Level Screen, 6th Edition
The Allen Cognitive Level Screen, 6th Edition (ACLS-6) uses observations of standardised activities to help determine what type of quality of information captures attention and how the information is being used. All these observations of how a person is processing information gives the therapist a variety of information so they can objectively make a clinical judgement on what is a reasonable and realistic expectation of what the person is able to manage and how to modify activities or create activities which captures their attention.
What is the Allen Cognitive Disability Model?
The ACDM looks at how the ACLs can be used to keep the person with a cognitive disability occupied and happy. When a cognitive disability is not identified, poor motivation or apathy are often used to explain why someone is no longer carrying out their customary activities. Nothing further is done to address their poor performance. When the person's ability to function is objectively measured and what they can and cannot do is identified then adjustments may be made to allow reengagement. Individual differences and confounding factors requires addressing to enable a good match to occur. The therapist works with the person and their carers on how to modify the activity so that it is achievable, such as the use of automatic pill dispensers to assist with medication management.
Some activities however cannot be modified to fit within the person's functional capacity. Individualised compensatory supports will need to be put in place. If someone is having difficulty managing their finances, they may choose to have their mail diverted to a close family member whom they trust to handle their affairs. Another person may choose to have their regular bills direct debited from an account and their financial matters managed in consultation with a financial advisor.
Having a cognitive disability often causes disengagement in customary activities as the person with a disability does not realise what information they no longer pay attention to that others around them perceive. Things that they often want to do from past experiences is too difficult now and easier tasks are less appealing. Carers who are justifiably concerned may also put restrictions in place to minimise negative consequences. This can create a situation where the person is left with nothing to do but cause trouble. By identifying what the person can do, these skills can be used in meaningful activities that keeps the person happily occupied. This will reduce the carer's stress and burden.
The ACDM is a way of addressing cognitive deficits by advocating for a "just right" challenge. It allows the individual to function to the best of their ability through careful measurement of global ability to function and use of environmental and social supports. This is part of an occupational therapist's professional role and specialty.