Functioning in ACL 4 High increases the person's chances of living in the community with some support. However, when there are major changes to the living situation, these activities may no longer be supported. When the person cannot participate in these activities than other activities will need to be added, otherwise the person may be left with nothing to do.
The use of images frees people from total dependence on what they learned in the past because they are able to compare and evaluate what they are doing with a sample. The sample is the concrete representation of the standard of performance. Any new information must be perceivable in the sample. Verbal descriptions simply pass them by without making an impression. People with a history of polite social manners may nod their head when they have no idea what you are talking about.
The application of reading, writing and arithmetic are only a little better than ACL 4 Low. Within ACL 4.8, they may check off steps for doing an activity on a checklist written by someone else when the checklist is limited to the nouns and verbs read by 6 to 9-year-olds. When walking around the neighborhood, they are more apt to use landmarks than street signs to avoid getting lost. When shopping, they tend to select familiar packaging only when at eye level. A short drama or comedy show may be watched on TV. They pay attention to demonstrated instructions, but usually do not remember the content or apply verbal instructions and discard written instructions, warning labels, and precautions.
"I like it like that" indicates a comparison between what they did and a sample.
The person's perseverance may form a sense of achievement.
The person may not self-initiate activities between sessions and a regular schedule of three sessions a day must have a group leader.
During a one-hour session, the person may stop when a mistake is noticed or continue on with a request for more time if not done yet.