ACDM

The 2016 Allen Cognitive Disability Model (ACDM) and Allen Cognitive Levels (ACLs) have a new anchor, the quality of sensorimotor information that arouses attention. The differentials between the 25 ACL modes are clearer because definitions of aroused attention and the connected behaviors that cause effects are more explicit. The quality of sensorimotor information is much better than the prior descriptions of behavior because information is in all actions and activities.

For example, generalizing from leather lacing to different activities that they can do is much easier. Activity analysis, using the definitions of attention and causing effects, has been applied to creating lists of actions and activities connected to the 25 ACL modes. The old standbys are making more sense too. No radical changes in the 25 ACL modes will be found in the 2016 edition, but it is certainly easier to select activities that might work and to differentiate between the modes.

The neurosciences have finally had something useful to say about how the brain functions as a unit. The physiological operations that supply the fuel for arousing attention, information processing speed and sustaining attention are reduced by brain pathology. Wow! Perfect. That makes clinical sense. We know that: higher level cues pass over their heads; that they are slower than molasses in January; and that their attention spans are short. Response time and sustained attention time can be measured in seconds or minutes on a smartphone (high tech stop watches). Two new measures are already producing good methods, outcome measures, and predictive guidelines.

The information that arouses attention, slowly, for a short period of time makes it easier to describe patterns of activity performance. Those patterns have provided a better understanding of what the world must look like to a person with a cognitive disability. The Allen Cognitive Worldviews (ACWs) contains descriptions of the person’s perspective for the 6 ACLs and the 25 ACL modes. Their sense of identity, ownership, independence and social roles brought startling insights.

The cause of so many refusals to do what they can do, drop outs from programs and the fallacies in self-reports are explained by obsolete identities and oblivion to their dependence on other people. Their worldview is stuck in a time zone before the onset of a cognitive disability and lack of awareness of their fundamental dependence on other people is encapsulated. Millions of misunderstandings for themselves and other people who believe what they say are identified.

To appeal to their obsolete identities, actions and activities that they can do are presented in appealing packages. The quality of information generalizes into new approaches to ancient conflicts by modifying the actions and activities so that they appeal to their obsolete identities. Some creativity is required to modify the old standbys so that they can do a simple activity with attractive contents. For example, a person who is stuck on golf may be willing to try pursuing golf content in a word finding puzzle, jigsaw puzzle, picture to paint or color, sorting colored golf balls, golf swing exercises, or taking mock clubs in and out of golf bags. The supplies have to be just right so they can do it and be safe.

Guidelines for coping with these problems led to the development of another version of the ACLs. The 10 ACL profiles take on the horrific difficulties with predicting human behavior in individual cases, i.e. discharge recommendations. The sensitivity and accuracy in the 25 ACL modes is a reasonable expectation when therapists are present to make adjustments as needed, but predicting what a person will do in a different setting doing a different activity with that precision is ridiculous. Alone, the 10 ACL profiles may not be much better.

The problem is about a thousand causes of inconsistencies in the patterns of activity performance. Common inconsistencies and recommended adaptations are identified in the 25 ACL modes for: physical disabilities, procedural memories, prior knowledge, and visual and auditory impairments. Even with those in place, a lot of confounding factors remain. The 10 ACL profiles do not require as much precision and the first step is to see if we can consistently produce measurable, effective actions and activities. Ratings for the 10 ACL profiles are included in the Allen App. The second step is predicting the effects of uncommon inconsistencies in patterns of activity performance and that step requires practical experience and competency in doing independent activity analysis. Therapists will need to synthesize that information to make discharge recommendations and set-up home programs, which is a difficult new role. Functional profiling is the service that is badly needed to make the transition from acute to long-term care.

The familiar maintenance programs need a better name and purpose. Affirmative programs accept the person with a cognitive disability as they are right now and they can stay in the program as long as they want to. Staff members are not allowed to badger them about their deficiencies or argue about their obsolete identities. Affirmative actions and activities are produced so that the person can and will do them. Meeting both of those criteria is tough, but with the 25 ACL modes, ingenuity and sharing ideas on the Allen Forums, we can do it. The may do requires long-term planning and advocating for political support and funding.

In addition, the sixth edition of the Allen Cognitive Level Screen (ACLS-6) includes new activities that teach you how to generalize beyond leather lacing. By learning to apply the definitions of attention and causing effects in standardized activities, you will understand the fundamentals that can be applied to an analysis of any activity the person wants to do. Analysis for ACL 1, 2, and 3 are included, with an opportunity to help pilot test new criteria for ACL 4.6, 4.8 and 5.0.

All of these developments have been published in the Allen App. By subscribing, you will have access to the 2016 ACDM, the 6 ACLs, the 10 ACL profiles, the 25 ACL modes, the 6 ACWs, the 25 ACWs, standardized activities for the 25 ACL modes in the ACLS-6, and appendixes full of activity analysis for 25 ACL modes for a lot of affirmative actions and activities, ADLs and IADLs, and adaptive equipment for physical disabilities.