The Allen Cognitive Level Screen, 6th 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 behaviour in three leather lacing stitches.
All of the editions share the limitations of standardised actions or activities. Limited observations in highly selective actions and activities cannot adequately represent a global cognitive ability to function. Numerous, undetected inconsistencies are highly likely and performance in different types of activities is unknown. A narrow scope is a limitation of standardised tests.
Stitching Activity
Prior editions of the ACLS only included the leather lacing stitches, and the range was limited to ACL 3.0 through 5.8. The internal consistency of the ACLS-90, ACLS-5, and the ACLS-6 editions was tested and all three editions got the same scores.
Two limitations in leather lacing stitches have been found and corrected in the descriptions of the 25 ACL modes but will still be apparent in the ACLS-6 scores for stitching. The differential between ACL 3.2 and 3.4 is not evident in a running stitch and simple colouring is recommended as a better assessment. The differentials between ACL 4.6, 4.8, 5.0, and 5.2 lack sufficient clarity. Better assessments are the copying a design, diamond colouring, and peanut butter.
Additional Activities
Additional activities have been added to the ACLS-6 so that the complete range of ACL scores from ACL 1.0 to 5.8 could be tested.
Some of the new activities have been created so that local supplies can be used which reduces the cost of shipping.
More activities will be added over time so that we have a comprehensive library for therapists to choose from.
Inter-Rater Reliability
The 6th edition of the ACLS removes the 5th edition's details from the standardised administration and scoring of stitching. The psychometric property that is retained is inter-rater reliability. All therapists should check their inter-rater reliability with other therapists. Reliable scores at the beginning of care anchors all therapists at the same place when giving a number to the same quality of information used. Our confidence in clear communication with therapists all over the world is important. For example, ACL 3.4 versus 3.6 should refer to the same qualities in patterns of performance for each number, with the same characteristic differences between the numbers. That is a lot of information conveyed by two numbers, and we need to be confident that some unknown person is reporting the numbers accurately. Inter-rater reliability on a standardised test protects our confidence in each other, but it does not do a thing for the person with a cognitive disability. Helping the person depends on how you use the numbers, which requires verification and confirmation through clinical reasoning.