The striking features in the selection of the beads are colour and number. Sewing the beads requires attention to the horizontal and vertical planes. Instructions for this activity can be found in the download section of https://www.acdmweb.com.

Posters for the seasons and holidays can be made if someone will draw a big, traditional shape, such as a 6 foot (1.8 m) Christmas tree on a huge piece of white paper. Give people access to pieces of green tissue paper. They can crinkle the paper and stick it on with rubber cement during the first session. During the next session they can stick on the ornaments, which are different colours of tissue paper.

It will take some planning ahead for them to have access to the top and bottom of the poster. Try stapling the folded top to a dowel that can be raised or lowered.

The concept of trash enters the scale in ACL 4.4. When told, they will usually make a note of the trash and follow verbal cues to clean up. Without direction, the trash is often left where it is. When living alone, the tendency to not remove the trash often becomes a health hazard.

Sensory information may be used to capture a person's attention if they are anxious. Pleasant and calming sensory information may be used by the person to modulate their anxiety.

Concrete rote learning is limited to storing a pair of features and using them throughout the activity. The person may store a pair of features in their memory after following a demonstration of how to correct an error. This is apt to be a slight modification in a habitual sequence.

Memory is often better for older events than recent ones. Good declarative memories for names, dates, geography, politics and historical events may be used, but the scope of what is remembered may be shallow.

A better understanding of a cognitive disability will lead to less stigma within this group. Functioning within ACL 4.4 often results in them having obvious difficulties, but a diagnosis is often avoided as a negative label is shunned upon.

As long as they are quiet and compliant, staff members tend to overlook their existence.

The need for something to do between meals is often overlooked. They do not watch TV or read. Electronic games may be the alternative.

The person is likely to have good verbal skills and be able to describe what they would like to do. Do not overwhelm the person by providing several choices at once. Choosing between two items works best for them.

Social awareness includes the norms for language, clothing, body adornments, seasons, etc. The person usually excuses themselves when the social norms are broken by them. When others break the norms, they tend to stay away from that person.

ACL 4.4 is functionally illiterate for most people operating within this mode. There are a number of people who can read aloud correctly and have no idea what they read. If so, they will probably not recognise the functional illiteracy and take steps to compensate for the problem, which is a serious concern for living alone and driving alone.