Some people will accept a lifelong cognitive disability and collaborate to plan for adjustments in their lifestyle. Accepting grim realities may be necessary but it is not easy. Those who do, appreciate educational information, but are vulnerable to exaggerated claims of predictive validity. Human behaviour has lots of inconsistencies such as past training and habits. This over-exaggeration may make the ACLs vulnerable to abuse.

The comprehensive effects of a cognitive disability are not observable until people stop talking. Within ACL 3 Low, denial is no longer possible because these people cannot say much. Above ACL 3 High, the whole world has been denying the comprehensive effects for centuries. As you provide educational information, you can expect the phrase "to shoot the messenger" to acquire personal meaning. The reality is grim. Period.

From experience, a couple of precautions can be passed on.

Avoid illustrating a cognitive disability with one or two examples. Every example has been done by a normal person at some time. The folks who want to deny a cognitive disability will tell you when and how in more detail than you have time to listen to.

The person with a lifelong cognitive disability is dependent on other people to set-up and supervise the actions and activities that they can still do. Carer education and satisfaction is a major part of the occupational therapist's job. Helping them understand the enormous scope of a global restriction in ability to function is only the first hurdle. Patterns of performance help them understand what to expect. Patterns of performance describe consistent and specific actions and activities.

The focus of occupational therapists is to engage the abilities that the person still has. We can achieve this by:

The obsolete identity connected to a cognitive disability sustains their oblivion to the reduction in their cognitive abilities. What they can say about themselves often sounds better than what they can do. Self-reports are the primary method of gaining information about a person in doctor's offices, case management and legal proceedings. Self-reports usually contain information about the quality of their life before the onset of a cognitive disability, and decisions about their current life are incorrect.

Memories that are retained the longest with the most detail are highly emotional and not necessarily correct. With a cognitive disability, repeating the same story is apt to go on forever, without correction, or awareness of who is listening. Do not use the ability to recall long term memories as an indication of the person's mental capacity.

Between ACL 3 High and ACL 4 High, people depend on their procedural memories. Customary habits of a group of people are usually well known, but atypical habits are often particular to a job or living in a different community. When the performance of one activity is surprisingly better than the person's pattern of activity performance, an atypical procedural memory is often the reason. Simply asking, "Have you ever done anything like this before?" explains the connection to prior experience.

Specific impairments are focal deficits which have limited impact on the brain's global ability to function. Adjusting and accounting for such specific impairments is important as these can artificially reduce the person's performance. The testing procedures in the ACLS-6 have attempted to screen out some of these specific impairments with questions and assessment tasks aimed at testing the person's eyesight and hand function. Clinicians will need to ensure adaptive equipment such as glasses and hearing aids are used when cognitive disabilities are accompanied by additional impairments.

Flexibility may be the value of the human brain, but the inconsistencies that the brain creates can be a nuisance when trying to predict. Problems with predictions occur because the quality of information is only one factor among the many that influence what people with a cognitive disability can, will and may do. Their effects are discussed throughout the Allen App. The point of putting them here is a convenient list to remind you to consider the common confounding factors. In no way should anyone think that this list includes everything.