Brief History of the Allen Battery

The Allen Cognitive Battery consists of several tools for evaluating attention, problem solving, and learning in persons with brain conditions resulting in some cognitive restrictions. The idea of developing a scale to measure global functional abilities of persons with psychiatric disorders was originated over thirty years ago by Claudia Kay Allen, MA, OTR, FAOTA and her colleagues at Eastern Pennsylvania Psychiatric Institute in Philadelphia. A leather-lacing test, now known as the Allen Cognitive Level Screen (ACLS), was developed at this time to provide a quick measure of learning/cognitive abilities. The “Cognitive Levels”, as they were then called, consisted of six levels, measuring a continuum of clinically observable, qualitative differences in ability to perform functional activities. Work on the levels continued by Claudia and others at Johns Hopkins Hospital in Baltimore and subsequently at LAC+USC Medical Center in Los Angeles. A standardized procedure for administering the ACLS was developed in 1978 (D. Moore thesis). Several studies followed, establishing inter-rater reliability and correlations between the ACLS and other psychological tests including the Block Design of the WAIS, the Brief Psychiatric Rating Scale, Shipley Institute of Living Scales, and the Symbol Digit Modalities Test. Other studies examined the relationship of cognitive level, as measured by the ACLS, to different psychiatric disorders, and between normal and psychiatric populations. The standardized directions for the ACLS were first published in 1985 (Occupational Therapy for Psychiatric Diseases: Measurement and Management of Cognitive Disabilities, Allen. Boston, Little Brown, out of print) and revisions in ratings were made in 1988, 1990, 1996, and in 2000. The ACLS kit has been available for purchase since 1990 from S&S Worldwide, Colchester, CT. An enlarged version of the ACLS, the Large Allen Cognitive Level Screen (LACLS), was developed to compensate for vision impairments commonly found in geriatric populations.

The “Cognitive Levels” were expanded to 26 Modes of Performance to allow for more sensitive measurement of clinically significant functional improvements (Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled, Allen, Earhart, and Blue. 1992, Rockville, AOTA). In this text, a frame of reference for a clinical practice theory was first articulated. Included in this text was a second version of the Routine Task Inventory (RTI II). The RTI II is an analysis of common activities of daily living by mode, intended to verify the initial ACLS score and set treatment goals.
Within this text, Theressa Burns, OTR, introduced the Cognitive Performance Test (CPT). First developed in 1985, the CPT used performance of six standardized tasks of daily living to identify global cognitive abilities in persons with dementia. Subsequent research studies have demonstrated this instrument's efficacy in measuring change and predicting long-term risk of institutionalization in populations with progressive dementia (Burns, Mortimer, and Warmbler, 1991.)

The Allen Diagnostic Module (ADM) by Earhart, Allen, and Blue, (1993, Colchester, S & S), a collection of 26 standardized craft tasks, was developed to verify the initial ACLS scores of persons with moderate to mild global impairments (modes 3.0 - 5.8.) Expanded to include 35 tasks in 2004, the ADM has the distinct advantage of using working memory in new learning, thus avoiding procedural memory tasks that may inflate performance scores.

The Sensory Motor Stimulation Kits I and II by Blue (1995, Colchester, S & S) were designed to assess and treat the most severely impaired persons (modes 1.0 - 3.2) often encountered in geriatric and rehabilitation medicine practice areas.

The Allen Scale is currently used by therapists across a broad range of practice areas, including mental health, forensic psychiatry, rehabilitation medicine, and geriatric care. Specific application varies by setting and the clinical problem to be solved. In acute care settings, changing functional capacities are assessed and monitored for anticipated improvements. In post-acute or stable conditions, the Allen Scale provides an activity analysis to identify the cognitive and motor requirements of meaningful activities that the person wants to do, leading to treatment goals that match current abilities. Methods of teaching or training compensatory or new skills are inherent in the mode of performance. In deteriorating conditions, therapists may recommend meaningful activities that help maintain capacities, protect the person’s safety, and reduce the burden of care. Understanding remaining abilities fosters a realistic optimism for success in community life.

The Allen Cognitive Network encourages collaboration and exchange between clinicians, educators, students, and clients in the continuing quest to understand the nature of functional abilities and disabilities. Welcome to the journey!

Cathy Earhart, OTR/L
March 12, 2005