Purpose
The ACLS measures functional cognition in individuals whose behavior appears to reflect impairments in cognitive processing.
Link to Instrument
The ACLS measures functional cognition in individuals whose behavior appears to reflect impairments in cognitive processing.
3
20 minutes
Child
6 - 12
yearsAdolescent
13 - 17
yearsAdult
18 - 64
yearsElderly Adult
+
yearsBerglund, Olivia; Coronel, Martina; Rath, Jonathan; Sheehan, Hannah
(Master of Occupational Therapy Students)
Faculty mentor: Danbi Lee, PhD, OTD, OTR/L
Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
The ACLS-5 is the most current version, published in 2007 and revised in 2009. The assessment should be used for individuals with adequate or adapted fine motor skills, vision, and hearing. The Large Allen Cognitive Level Screen (LACLS-5) version is available for further accessibility.
Additional versions of the ACLS that are included in this measurement summary include ACLS-90, the 1990 version of the ACLS, and the ACLS-2000, the version of the instrument published in 2000.
Inpatient Psychiatric Patients: (David & Riley, 1990; n = 71 patients admitted to general hospital psychiatric unit during a 13-month period; Mean Age = 36.99 (12.18); mood disorder, 54%; schizophrenia, 13%; adjustment disorder, 11%; anxiety disorder, 6%; impulse control disorder, 4%; somatoform disorder, 4%; psychoactive substance use disorder, 4%; organic mental disorder, 1%; various other diagnoses, 3%)
Predictive validity:
Schizophrenia (Chan & Yeung, 2008; n = 201; Mean Age = 43.14 (9.9); Chinese sample)
Schizophrenia (Velligan et al., 1998; n = 110; Mean Age = 35.7 (9.7); subjects discharged from state hospital over 3 year period, follow-ups 1.5-3 years post-discharge)
Schizophrenia (Secrest, et al., 2000; n = 33 adult men with schizophrenia or schizoaffective disorder; Mean Age = 47.94)
Inpatient Psychiatric Patients: (Henry et al., 1998, n = 100 inpatients consecutively admitted to acute mental health unit of hospital during a 6-week period; Mean Age = 39.57 (14.75); schizophrenia, bipolar disorder n = 39; major depression, PTSD/dissociative disorder, anxiety disorder n = 61)
Concurrent validity:
Inpatient Psychiatric Patients: (Scanlan & Still, 2013; n = 225 individuals from eight inpatient psychiatric units; Mean Age = 39.6 (13.2); schizophrenia n = 154; schizoaffective disorder n = 20; other psychoses n =14; bipolar disorder/mania n = 12; depression n = 11; “other” n = 14)
Schizophrenia (Leung & Man, 2007; n = 61 chronic schizophrenic patients, Mean Age = 45.07; n = 61 more than 6 months stay in existing psychiatric setting, Mean Age = 29.84; Chinese sample)
Schizophrenia (Velligan et al., 1998)
Schizophrenia (Velligan et al., 1995; n = 110; Mean Age = 34.6 (7.5); subjects experienced consecutive admissions to inpatient hospital over 18 months)
Schizophrenia (Keller & Hayes, 1997; n = 58; n = 41 living in community, n = 17 living in long-term psychiatric hospital; Mean Age = 35.50 (9.85))
Schizophrenia (Leung & Man, 2007)
Schizophrenia (Su et al., 2011; n = 76; n = 35 scored 4 on ACLS, Mean Age = 37.83 (10.25); n = 41 scored 5 on ACLS, Mean Age=37.73 (9.28); Taiwanese Sample)
Schizophrenia (Chan & Yeung, 2008)
Convergent Validity:
Substance Use: (Rojo-Mota et al., 2017; n = 232 participants with addictions currently undergoing addiction rehabilitation treatment; Mean Age = 38.26 (11.66); Spanish sample)
Inpatient Psychiatric Patients: (Schubmehl et al., 2018; n = 193 inpatients from a psychiatric unit in California in acute phase of a psychiatric illness diagnosis; Mean Age = 37.2 (14.4); schizophrenia, n = 47; schizoaffective disorder, n = 45; psychotic disorder NOS, n = 23; bipolar disorder, n = 53; major depressive disorder, n = 19)
Inpatient Psychiatric Patients: (David & Riley, 1990
Inpatient Psychiatric Patients: (Mayer, 1988; n = 40 adult acute psychiatric inpatients; Mean Age = 33.0 (17.9); Mean Chronicity = 7.5 (6.9))
Convergent Validity:
Pediatric Mental Health: (Shapiro, 1992; n = 24 males with an emotional disturbance attending a private school in New York; Mean Age = 12.5(Range = 8-15))
Known Groups Method:
Pediatric Mental Health: (Lee et al., 2003; n = 61 consisting of 32 adolescents living in the community and 28 adolescents residing in residential mental health facilities; Mean Age = 14.8 (1.5))
Older Adults and Dementia (Wesson et al., 2017; n = 87 older adults with no cognitive impairment, Mean Age = 82.5; n = 43 older adults with mild cognitive impairment (MCI), Mean Age = 83.1; n = 30 older adults with dementia; Mean Age = 79.2)
|
Cut-off Scores |
Sensitivity |
Specificity |
No cognitive impairment vs Dementia |
4.5 |
76.7% |
90.8% |
4.7 |
86.7% |
81.6% |
|
MCI vs Dementia |
4.5 |
76.7% |
74.4% |
4.7 |
86.7% |
60.5% |
|
No dementia (No cognitive impairment & MCI) vs Dementia |
4.5 |
76.7% |
85.4% |
4.7 |
86.7% |
74.6% |
|
No cognitive impairment vs MCI |
5.1 |
67.4% |
52.9% |
Older Adults and Dementia (Wesson et al., 2017)
|
No cognitive impairment |
MCI |
Dementia |
Mean (SD) |
5.13(0.41) |
4.94(0.47) |
4.45(0.40) |
Range |
4.4–5.8 |
4.2–5.8 |
3.4–5.8 |
Discriminant Validity
Older Adults and Dementia (Wesson et al., 2017)
Convergent Validity
Older Adults and Dementia (Wesson et al., 2017)
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 and LACLS Committee.
Chan, S. H. W., Yeung, F. K. C. (2008). Path models of quality of life among people with schizophrenia living in the community in Hong Kong. Community Mental Health Journal, 44, 97-112.
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, 493-497.
Henry, A. D., Moore, K., Quinlivan, M., & Triggs, M. (1998). The relationship of the Allen Cognitive Level test to demographics, diagnosis, and disposition among psychiatric inpatients. American Journal of Occupational Therapy, 52, 638-643.
Keller, S. & Hayes, R. (1998). The relationship between the Allen Cognitive Level test and the Life Skills Profile. American Journal of Occupational Therapy, 52(10), 851-856.
Lee, S. N., Gargiullo, A., Brayman, S., Kinsey, J. C., Jones, H. C., & Shotwell, M. (2003). Adolescent performance on the Allen Cognitive Levels Screen. American Journal of Occupational Therapy, 57(3), 342-346.
Leung, S. B. & Man, D. W. K. (2007). Validity of the Chinese version of the Allen Cognitive Screen assessment for individuals with schizophrenia. OTJR: Occupation, Participation and Health, 27(1), 31-40. https://doi.org/10.1177/153944920702700105
Mayer, M. A. (1988). Analysis of information processing and cognitive disability theory. The American Journal of Occupational Therapy, 42, 176-183.
Rojo-Mota, G., Pedrero-Pérez, E. J., Huertas-Hoyas, E., Merritt, B., & MacKenzie, D. (2017). Allen Cognitive Level Screen for the classification of subjects treated for addiction. Scandinavian Journal of Occupational Therapy, 24(4), 290-298.
Scanlan, J. N., & Still, M. (2013). Functional profile of mental health consumers assessed by occupational therapists: Level of independence and associations with functional cognition. Psychiatry Research, 208(1), 29-32.
Schubmehl, S., Barkin, S. H., & Cort, D. (2018). The role of executive functions and psychiatric symptom severity in the Allen Cognitive Levels. Psychiatry Research, 259, 169-175. https://doi.org/10.1016/j.psychres.2017.10.023
Secrest, L., Wood, A. E., & Tapp, A. (2000). A comparison of the Allen Cognitive Level test and the Wisconsin Card Sorting test in adults with schizophrenia. American Journal of Occupational Therapy, 54, 129-133. https://doi.org/10.5014/ajot.54.2.129
Shapiro, M. E. (1992). Application of the Allen Cognitive Level test in assessing cognitive level functioning of emotionally disturbed boys. American Journal of Occupational Therapy, 46(6), 514-520.
Su, C. Y., Tsai, P. C., Su, W. L., Tang, T. C., & Tsai, A. Y. (2011). Cognitive profile difference between Allen Cognitive Levels 4 and 5 in schizophrenia. American Journal of Occupational Therapy, 65, 453-461.
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 80, 287-198.
Velligan, D. I., True, J.E., Lefton, R. S., Moore, T. C., & Flores, C. V. (1995). Validity of the Allen Cognitive Levels assessment: A tri-ethnic comparison. Psychiatry Research, 56, 101-109.
Wesson, J., Clemson, L., Crawford, J.D., Kochan, N.A., Brodaty, H., & Reppermund, S. (2017). Measurement of functional cognition and complex everyday activities in older adults with mild cognitive impairment and mild dementia: Validity of the Large Allen’s Cognitive Level Screen. American Journal of Geriatric Psychiatry, 25(5), 471-482. https://doi.org/10.1016/j.jagp.2016.11.021
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.