Allen Scale / Cognitive Levels
The Allen Cognitive Levels scale or ACL Scale (Allen & Blue, 1998) was developed in the late 1960’s by Allen and colleagues through systematic observation and documentation of predictable patterns of performance of adults in inpatient mental health settings as they engaged in activities of daily living (ADLs), instrumental activities of daily living (IADLs) and leisure activities. An ordinal hierarchy of six distinct patterns of performance, or cognitive levels, was identified that was subsequently expanded to include 52 modes of performance. Cognitive levels and modes appear to reflect sets of underlying cognitive processes that affect functional performance, that is, motor actions and verbal behaviors observed as an individual engages in an activity (Austin, 2009).
The six cognitive levels are titled with the prominent, observable, voluntary motor actions associated with the level (Allen, Earhart, & Blue, 1992). The levels are a hierarchy of increasingly complex abilities, with the fewest and simplest available cognitive capacities and functional abilities described by cognitive level 1 and the most complex by cognitive level 6. The scale is cumulative, that is, individuals functioning within cognitive level 3 are assumed to have all the abilities described within cognitive levels 1 and 2 as well. It is also assumed also that an individual functioning within cognitive level 3 would not have abilities described by cognitive levels 4, 5, and 6. Thus, the same point on the cognitive levels scale identifies both the severity of cognitive disability and an individual’s available abilities.
Within each cognitive level, abilities are described with greater specificity by 5 modes of performance, indicated by an even numbered decimal after the level (e.g. 1.2, 1.4, 1.6, etc.) In her validity study of three Allen Diagnostic Module – 2nd edition (ADM-2) assessments, Austin (2009) found support for the use of the modes of performance within modes 3.0 to 4.8 as distinct gradations of capacity based on the Rasch method of analysis. The titles of the six cognitive levels and 26 modes of performance are described in the following table.
Titles of six cognitive levels and 26 modes of performance
|Titles of Levelsa||Titles of Modesb|
Generalized reflexive actions
|Level 1: Automatic actions||1.0
Withdrawing from noxious stimuli
Responding to stimuli with one sensory system
Rolling in bed
Raising body part
|Level 2: Postural actions||2.0
Overcoming gravity & sitting
Righting reactions/ standing
Using grab bars
|Level 3: Manual actions||3.0
Sustaining actions on objects
Noting effects on objects
Using all objects
|Level 4: Goal-directed actions||4.0
Sequencing familiar actions
Differentiating features of objects
|4.4 Completing a goal||4.6 Personalizing features of objects||4.8
Learning by rote memorization
|Level 5: Exploratory actions||5.0
Comparing & changing variations in actions & objects
Discriminating among sets of actions & objects
Considering social standards
Consulting with others
|Level 6: Planned actions||Typically functioning adult brain and functional cognitive capacities|
a Titles of the levels are a prominent, observable, voluntary motor action associated with the level
b Titles of the modes are an observable functional cognitive behavior characteristic of mode.
Allen, C. K. & Blue, T. (1998). Cognitive disabilities model: How to make clinical judgements. In N. Katz (ed.), Cognitive rehabilitation: Models for intervention in occupational therapy. Bethesda, MD: American Occupational Therapy Association.
Allen, C. K., Earhart, C. A., & Blue, T. (1992). Occupational therapy treatment goals for the physically and cognitively disabled. Bethesda, MD: American Occupational Therapy Association.
Austin, S. A. (2009). Hierarchies of abilities and activity demands in the Allen Diagnostic Module 2nd Ed.: A validity study (Unpublished doctoral dissertation.). University of Illinois, Chicago.