In an ordinal scale, verifying the score and ruling out a higher score is important. Clinicians need to make sure the person is able to pay attention to the quality of information which their score represents. Be sure to carefully verify the ACL score and personally examine the real activity environment before you offer an opinion. Distortions and important omissions are common in these situations. Secondary gain with a history of good verbal abilities, charisma or theatrics has a tendency to make sustaining your objectivity difficult.

Informal conversations are more productive than standardized interviews and need to be adapted per cognitive level.

When the person cannot talk or talk very little, a family member or a friend may be used to obtain reliable information.

People functioning within ACL 4 and 5 can talk and tell you about their history in doing activities. Educational and work histories are safe places to start an interview. When the person is functioning at ACL 3 and below, an observation of their activities will be a more productive use of your time.

Learning how to do a quick estimate starts to focus in on the person.

Making a quick estimate is required to select actions or activities for the ACLS-6.

The activities in the ACLS-6 can be used to get an Initial Evaluation, but those activities may not all produce the same score. Ability to function is a general pattern of performance with exceptions that are often explained by other medical impairments and the person's personal history in doing activities.

If you are using only the stitching (or lacing) test, it is known to produce scores that do not always match the person's pattern of performance.

Causing effects are behaviors connected to the sensorimotor information that aroused attention. Causing effects includes explicit descriptions of mental control of physical actions, the manipulation of material objects, and the use of hand and power tools. The connection between the cue and the behavior can be predicted by the content of the information, i.e. it tastes good and licking their lips.

Getting the person to pay attention is not as simple as yes or no because sustained attention is not the same for every activity, every person or even the same person at different times of the day. While there is some predictability about how much attention can be aroused with each ACL, that too has variations. The goal is to get the best and most attention as possible.

To observe aroused attention, you need to be in a position where you can see the action of the pupils of the person's eyes. The actions of the pupils of their eyes focus on the external information, followed by moving to the left or the right. In general, moving to the left indicates mental processing in the right hemisphere, where sensorimotor information is located, most of the time. Moving to the right indicates mental processing in the left hemisphere, where language information is located, most of the time.

People with a cognitive disability pay attention to qualities of sensorimotor information, which is applied to causing effects with motor actions. The simplest mental process can be divided into a sequence of steps:

The cognitively disabled person has thoughts and feelings that are the basis for making choices. When their attention is aroused, they may invest all of their available energy by forming cause and effect connections between the cues and their behavior.

The Allen Cognitive Level Screen, 6^th Edition (ACLS-6) is an assessment and learning tool designed to observe the effects caused by aroused attention in several actions or activities. The prior ACLS editions were designed to teach therapists how to observe and score behavior in three leather lacing stitches.