Multimodal LLMs are not all you need for Pediatric Speech Language Pathology

Child speech differs from adult speech in acoustics, prosody, and linguistic structures. Speech disfluencies (such as repetitions) further challenge automatic understanding. While Audio Language Models (ALMs) show strong semantic reasoning from speech audio, their ability to reason about disfluent child speech in mixed-speaker settings remains unexplored. We investigate this through two tasks: child-focused semantic summarization and speech entailment. Experiments use recordings of children who stutter in mixed speaker interviews without explicit speaker separation. Models are instruction-guided to focus on the child, preserve clinically relevant disfluencies, and avoid adult-speech leakage. Evaluation combines LLM-based judges and reference-based metrics, anchored by transcript-oracle baselines to isolate errors. Results show that while ALMs extract high-level meaning from stuttered speech, reasoning degrades significantly with increased

Speech large language models (SLMs) are typically built from text large language model (TLM) checkpoints, yet they still suffer from a substantial modality gap. Prior work has mainly attempted to reduce this gap from the output side by making speech generation more text-like, but the gap remains. We argue that the key remaining bottleneck lies on the input side. We propose TextPro-SLM, an SLM that makes spoken input more closely resemble that of a prosody-aware text LLM. TextPro-SLM combines WhisperPro, a unified speech encoder that produces synchronized text tokens and prosody embeddings, with an LLM backbone trained to preserve the semantic capabilities of the original TLM while learning paralinguistic understanding. Experiments show that TextPro-SLM achieves the lowest modality gap among leading SLMs at both 3B and 7B scales, while also delivering strong overall performance on paralinguistic understanding tasks. These gains are achieved with only roughly 1,000 hours of LLM training audio, suggesting that reducing the modality gap from the input side is both effective and data-efficient.

Accurate assessment of cognitive decline from spontaneous speech remains challenging due to limited dataset size and class imbalance. In this work, we propose a large language model (LLM)-driven data augmentation framework to improve the prediction of cognitive scores from speech. Experiments are conducted on a Japanese corpus in which each participant provides both a spontaneous oral narrative and a written response to the same clinical prompt. The written responses serve as semantic anchors to generate multiple oral-like monologues in different styles using GPT-5. We then predict Hasegawa Dementia Scale scores, a widely used cognitive screening tool in Japan, using a Partial Least Squares regression model trained on Sentence-BERT speech embeddings. We investigate two augmentation strategies: random class-balanced selection, which yields moderate but unstable improvements, and similarity-guided class-balanced selection. The latter prioritizes semantically close synthetic samples, leading to more consistent improvements and substantially reducing prediction error for minority low-score participants while maintaining performance for the majority group. Overall, our findings demonstrate the potential of semantically guided LLM-driven augmentation as a principled approach for addressing class imbalance and improving data efficiency in clinical speech analysis.