In ACL 4 High, the person is more able to follow the steps required to complete household management tasks. They are able to scan the environment looking for supplies required to complete their household management tasks. They have more ability to apply more pressure to different objects though this maybe hitting it harder or longer which may result in breakage. The ability to read simple instructions and follow a checklist also improves their independence. They do however have difficulty understanding verbal and written instructions in unfamiliar activities. When they have not been shown and trained how to do a new activity, these new instructions can cause confusion. The correct mental picture is not formed. Repeating the instructions louder or getting them to write down the instruction does not help. Someone has to demonstrate what they have to do in order for them to form the correct mental picture.
Within ACL 4 High, the person may live alone with regular support when they have been well trained with support being nearby to assist when they are confronted by new problems.