A Proactive Multi-Agent Dialogue Framework for Assessing Social Language Disorder Traits in Autism
Authors: Chuanbo Hu, Minglei Yin, Bin Liu, Wenqi Li, Lynn K. Paul, Shuo Wang, Xin Li
Organizations: Department of Computer Science, University at Albany, Albany, 12222, NY, USA. · Department of Management Information System, West Virginia University, Morgantown, 26506, WV, USA. · Humanities and Social Sciences, California Institute of Technology, Pasadena, 91125, CA,2026 USA. · Department of Radiology, Washington University in St. Louis, St. Louis, 63110, MO, USA.
Abstract
Characteristic linguistic behaviors associated with Social Language Disorder (SLD) in autism spectrum disorder, including echoic repetition, pronoun displacement, and stereotyped media quoting, are largely absent from spontaneous conversation and only emerge under specific conversational conditions. In structured clinical assessments, this latency means that questioning strategy selection is a critical yet underappreciated determinant of how much diagnostic information a conversation yields. Whether large language models (LLMs) can be guided to proactively select questioning strategies that systematically surface these latent traits remains largely unexplored. Here we present TPA (Think, Plan, Ask), a proactive multi-agent dialogue framework applied to the language assessment component of the Autism Diagnostic Observation Schedule Module 4 (ADOS-2), in which a doctor agent explicitly reasons about which traits remain unobserved before selecting a clinically grounded strategy and generating a targeted question. A patient agent grounded in real ADOS-2 clinical data enables reproducible evaluation without real patient participation, validated across three independent experiments confirming adequate fidelity to real patient language. Evaluated on 484 episodes from 35 patients, TPA outperforms six competitive dialogue planning baselines across all primary metrics, achieving 82.1% SLD trait coverage, 16.6% higher than automated replay of real clinical dialogues conducted by trained clinicians (65.5%), with substantially greater per-turn diagnostic efficiency (AUCC: 0.628 vs. 0.458, absolute gain +0.170). These results demonstrate that proactive questioning strategy selection substantially improves the efficiency of automated SLD trait assessment, with direct implications for scalable AI-assisted clinical screening.
The sycophancy of large language models can increase the safety risk in intervention dialogue for autistic children. Supervised fine-tuning can somewhat reduce sycophancy, but relying solely on positive examples is often insufficient to identify and correct failure patterns. We observe that sycophancy behaviors can often be localized to a limited span within the model response. In this regime, sequence-level preference optimization can over-update preference-irrelevant tokens and degrade intervention ability. To address this, we propose the \textbf{M}inimal \textbf{E}dit \textbf{D}ata \textbf{A}ugmentation (MEDA) strategy to construct controlled, stable, minimal edit preference pairs and \textbf{T}oken-level \textbf{D}ifference \textbf{D}irect \textbf{P}reference \textbf{O}ptimization (TD-DPO), which upweights difference tokens between chosen and rejected responses while downweighting shared tokens to suppress background drift. Extensive experiments across multiple backbones and evaluators show that TD-DPO achieves a better trade-off between sycophancy mitigation and intervention ability retention in our offline settings, highlighting its potential as a practical alignment approach for autism intervention.
The clinical management of autism spectrum disorder (ASD) faces a bottleneck in early screening, mainly because trained specialists are scarce and conventional assessment tools are subjective. Here, we introduce ASDchat, a multimodal large language model designed for evidence-based ASD screening, which takes video, audio, and dialogue as input. ASDchat adopts a dual-branch architecture, where the decision branch generates screening probabilities and the evidence branch generates traceable, timestamped behavioral evidence aligned with standardized clinical criteria (ADOS-2). The model was trained and evaluated on a dataset of 1,035 participants from 27 sites in China, which covered typically developing (TD) children, children with ASD, and children with other disorders. For ASD versus TD, ASDchat reached an area under the receiver operating characteristic curve (AUC) of 0.953 ± 0.021. On 9 held-out sites that were not used for training, the mean AUC was 0.932. Furthermore, unsupervised clustering of the behavioral dimensions split the ASD cases into six subtypes with different phenotypic profiles, and ASDchat suggests an intervention for each subtype. ASDchat provides a feasible path for large-scale, evidence-based early ASD screening in clinical practice.
Large language models (LLMs) can generate fluent dialogue, but prior works lack situational grounding, dynamic strategy control, and evaluation aligned with clinical standards in motivational interviewing (MI). We introduce StoryMI, a multi-LLM agent framework for controllable MI dialogue generation, where questionnaire-based client profiles are expanded into situational stories that provide narrative context for the dialogue. Therapist and client agents generate MI-coded utterances guided by MI codes selected by the interaction agent, while an interaction agent dynamically coordinates exchanges to control MI strategies during a multi-turn conversation. We propose a two-level evaluation protocol: lexical metrics and MI-specific measures of macro-level counseling strategies, alongside LLM-as-judge and human expert assessments. We construct a dataset of 6K simulated MI dialogues grounded in 1K questionnaire-story pairs, covering 12 MI codes and 13 symptom domains, and benchmark six open- and closed-source LLMs. Our results show that situational grounding and macro-level control can improve MI adherence and clinical plausibility, demonstrating the effectiveness of a structured multi-agent workflow for psychotherapy dialogue generation. We provide code and data for reproducibility.