Allen Cognitive Levels
By Stephanie Shane OTR/L
Pass the OT
Helpful Video to watch: https://www.youtube.com/watch?v=kqbi6kBbK5g
(Helpful way to remember the levels) Mnemonic
 Adorable Plush Museums Give Easy Pictures
 Automatic, Postural, Manual, Goal-Directed, Exploratory, Planned
Type of assessment: Standardized screening
The assessment purpose: The screen is used to obtain a quick measure of global cognitive
processing capacities, learning potential, and performance abilities and to detect unrecognized or
suspected problems related to functional cognition.
Determining a developmentally disabled adult’s level of cognitive function. MOST helpful for:
 Identifying the client’s difficult behaviors that might interfere with intervention.
 Planning a training program to improve prevocational skills.
 Identifying the type of environmental support that can maximize the client’s level of
function.
 Developing an educational plan to improve social skills.
 Population: adults with psychiatric or cognitive dysfunction and for adults with dementia,
the ACLS-5/LACLS-5 is recommended for use with populations whose patterns of
functional behavior appear to reflect disruptions in global cognitive processing capacities
as described by the cognitive disabilities model. The professional literature describes
applications with adolescents with psychiatric problems and with adults who have
experienced a traumatic brain injury or a cerebral vascular accident.
Domains or subtests: “Functional cognition” encompasses functional performance abilities and
global cognitive processing capacities. It incorporates the complex, dynamic interplay between
1) a person’s information processing abilities, occupational performance skills, values and
interests, 2) the increasingly complex motor, perceptual and cognitive activity demands of three
graded visual-motor tasks and 3) feedback from performance of these tasks in context.
Qualifications needed to administer: Occupational therapists or other health care professionals
who have experience working with persons with temporary or permanent cognitive impairments,
training in the use of standardized assessments, and training or mentoring in use of the cognitive
disabilities model and related assessments.
Allen cognitive level leather lacing task- structured task that allows the therapist to observe the
individual performing 3 increasingly complex stitches and make determinations about that
person’s cognitive level
Level 1: Automatic Actions

Characterized by automatic motor responses and changes in the autonomic nervous
system. Counsciousness to the external environment is minimal.

Automatic Actions/Reflexive--> TOTAL ASSIST

Motor Actions: walking, eating, drinking, standing

Attention Span: Seconds

Activities: Sensory Stimulation
Level 2: Postural Actions

Characterized by movement that is associated with comfort. There is some awareness of
large objects in the environment, and the individual may assist caregiver with simple
tasks

Unable to imitate the running stitch

Postural Actions/Gross Body Movement-MAX ASSIST

Motor actions: approximate imitations, pacing, bending, stretches

Activities: gross motor games, dance

Attention Span: minutes
Level 3: Manual Actions
 Begins with the use of the hands to manipulate objects. The individual may perform a
limited number of tasks with long-term repetitive training.
 Able to imitate the running stitch, three stitches
 Imitates 3 'running stitches'
 Repetitive Actions-->MOD ASSIST



Motor Actions: manipulation of familiar objects, react spontaneously to tactile
stimulation
Attention Span: 30 minutes; no written directions; increased distractibility
Activities: performs familiar ADL's (face washing, etc)
Level 4 Goal Directed Actions
 Characterized by carrying out simple tasks through to completion. The individual relies
heavily on visual cues. He/she may be able to carry out established routines but cannot
cope with unexpected events.
 Able to imitate the whip stitch, three stitches
 Imitates 3 'whip stitches'
 Goal Directed/Familiar Activities-->MIN ASSIST
 Sensory Responds to Visual Stimuli
 Activities: Visual cues to complete tasks, matching, several step-tasks, simple crafts (2-3
steps);
 NO NEW LEARNING/GENERALIZATION
 ex. Cereal into a bowl, grocery list, getting items,
getting dressed.
 Attention Span: Hours
 At 4.6 a person can live alone.
Level 5: Exploratory Actions
 Overt trial and error problem solving. New learning occurs. This may be the usual level
of functioning for 20% of the population.
 Able to imitate the single cordovan stitch using overt trial and error methods, three
stitches
 Imitates 'simple cordovan stitch' using Overt trial and error X 3 stitches.
 Independent learning/Exploratory --> self control/inclusive reasoning
 Alters actions with overt trial and error; poor organization, planning, and socialization
 Activities: Concrete tasks; NEW LEARNING AND GENERALIZATION
 Attention Span: Weeks
Level 6: Planned Actions
 Absence of disability. The person can think of hypothetical situations and do mental trial
and error problem solving. think of hypothetical situations, plan ahead to prevent
mistakes
 Able to imitate the single cordovan stitch using covert trial and error methods, three
stitches
 Imitates 'single cordovan stitch' X 3 with overt
trial and error
 Planned Action--> INDEPENDENT/Conceptual
 Considers consequences of actions
 Follows multistep verbal/written cues
 ABSENCE OF COG DISABILITY
QUESTIONS
1. A patient recently got admitted to an acute inpatient psychotic hospital after a relapse. In
a screening, the OT observes that the patient is able to follow simple steps such as getting
her hairbrush and construct a simple craft such as gluing construction paper together only
when there are written directions. The OT notes that the patient is at what ACL level?
a. 4
b. 2
c. 3
d. 5
2. If a patient cannot perform the running stitch, what is the next step the OT should do?
a. Re-administer the evaluation and modify the verbal directions for the running
stitch
b. Administer the lower cognitive level test
c. Delay evaluating the client until he she becomes more lucid
d. Have a more experienced therapist administer the acl
3. The ACL is most helpful for determining what about a patient?
a. Identifying the client’s difficult behaviors that might interfere with intervention
b. Planning a training program to improve prevocational skills
c. Identifying the type of environmental support that can maximize the client’s level
of function
d. Developing an educational plan to improve social skills
4. What can a patient accomplish at Allen's Cognitive Level 1?
a. Automatic actions
b. Exploratory actions
c. Planned actions
d. Goal directed actions
5. What can a patient accomplish at Allen's Cognitive Level 2?
a. Aware of large objects an can accomplish very simple tasks
b. Patients use hands for simple, repetitive tasks
c. Patients are able to copy demonstrated directions
d. Individuals can copy a sample plan to follow
6. What can a patient accomplish at Allen's Cognitive Level 3?
a. Patients use hands for simple, repetitive tasks
b. Patients are able to copy demonstrated directions
c. Individuals can copy a sample plan to follow
d. Patients use hands for simple, repetitive tasks
7. What can a patient accomplish at Allen's Cognitive Level 4?
a. Individuals can copy a sample plan to follow
b. Patients use hands for simple, repetitive tasks
c. Patients are able to copy demonstrated directions
d. Aware of large objects an can accomplish very simple tasks
8. What can a patient accomplish at Allen's Cognitive Level 5?
a. Patients perform tasks involving three familiar steps and one new one
b. Individuals can copy a sample plan to follow
c. Patients use hands for simple, repetitive tasks
d. Patients are able to copy demonstrated directions
9. What can a patient accomplish at Allen's Cognitive Level 6?
a. Patients perform tasks involving three familiar steps and one new one
b. Individuals can copy a sample plan to follow
c. Patients use hands for simple, repetitive tasks
d. Patients can anticipate errors and plan ways to avoid them
Answers
1.A
2. B
3. C
4. A
5. A
6. D
7. C
8. A
9. D