When Rating Scales Fall Short: LLM-Assisted Discovery of ADHD Signals in Turkish Teacher Narratives
Authors: Baris Karacan, Irem Aktar Songur, Ahmet Ozaslan, Elvan Iseri
Organizations: Department of Computer Science, University of Illinois Chicago · Department of Child and Adolescent Psychiatry, Gazi University
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, and its diagnosis relies on assessments combining clinician judgment with standardized rating scales and reports from parents and teachers. While structured instruments such as the Conners' Teacher Rating Scale-Revised Short Form (CTRS-R:S) quantify ADHD-related behaviors, teachers also provide open-ended narratives that may contain complementary signals not captured by structured assessments. However, it remains unclear to what extent teacher narratives encode signals overlooked by rating scales. In this study, we analyze de-identified Turkish teacher evaluation forms collected during clinical ADHD assessments, including both CTRS-R:S scores and open-ended teacher narratives. We compare predictive signals from structured scores and narrative text and identify cases where structured assessments fail to clearly distinguish ADHD from non-ADHD students while narrative-based models capture distinct behavioral patterns. Notably, these cases show minimal overlap with those missed by the narrative model, suggesting that structured and narrative information encode complementary signals. To interpret these differences, we apply a large language model (LLM)-assisted theme discovery pipeline that reveals distinct attention, behavioral, and family-related patterns, highlighting the potential of natural language processing (NLP) to uncover clinically relevant signals from teacher narratives and to complement traditional ADHD screening tools.
This paper describes our submissions to eRisk 2026 Task 3, ADHD Symptom Sentence Ranking. The task requires systems to rank candidate Reddit sentences according to their relevance to each of the 18 symptoms in the Adult ADHD Self-Report Scale (ASRS-v1.1). Because no annotated training data were released for this first edition of the task, we relied on zero-shot experimentation, manual validation, and unsupervised or weakly guided retrieval pipelines. Our systems combine sparse BM25 retrieval, evidence-aware rescoring for self-referential symptom reports, embedding-based reranking, query-prototype expansion, and LLM-based reranking. All submitted systems follow a staged retrieval design in which BM25 retrieves candidates at scale and semantic or LLM rerankers refine the final rankings. Among our submissions, the LLM reranker achieved the strongest official scores, followed by the prototype query-expansion run. Our manual top-10 analysis aligned with the official expert scoring trend, suggesting that staged reranking is a promising direction for further development.
Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.
LLMs now sit on every side of evaluation: as examinees scored on benchmarks, judges of other models' outputs, and raters of human-generated content. Each paradigm can be viewed as a measurement problem, where a latent property of an object is probed with items from an instrument (e.g., benchmark) by judges or raters. Standard evaluation practices often neglect the contributions of each core component to the end result, limiting our understanding of what is being measured. Rasch measurement theory (RMT) is well-suited to this problem. RMT decomposes ordinal ratings into separable facets on a common scale. It further provides a battery of diagnostics that can identify miscalibrated measurements and rater biases. We present a case study of RMT applied to the LLM-as-rater paradigm using the Measuring Hate Speech corpus, whose construct was itself built under RMT. We fit a series of many-facet Rasch models to annotations from nine LLMs spanning families and capability levels. Our analyses show that LLMs systematically differ from human raters in severity, item-level calibration, question-order robustness, target-identity sensitivity, and rating scale use, all of which standard evaluation practice would largely obscure. Overall, we argue that RMT belongs in the toolkit for evaluating LLM-as-examinee, -judge, and -rater paradigms.