Consisting of a test of learning three increasingly complex sewing stitches on a piece of leather, the ACLS was developed to provide a quick measure of learning and problem-solving abilities. A standardized procedure for administering the ACLS was developed in 1978, and several studies established correlations between the ACLS and other psychological tests, such as 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 “Occupational Therapy for Psychiatric Diseases: Measurement and Management of Cognitive Disabilities.”