“…While the utility of adjustment factors in enhancing clinical accuracy has substantial support in the psychometric literature (see Choca, 2004), their use contributes further complexity to the MACI’s already complex scoring system. Thus, although clinically useful, the uncommon scoring conventions used by the MACI and other Millon instruments may also serve to confound scale interpretation and negatively affect content validity (see Choca, 2004; Nurnberg, Hurt, Feldman, & Suh, 1987; Nurnberg et al, 1991; Rossi, Elklit, & Simonsen, 2010).…”