Towards Dys-XAI: Influence-Based Explanations for Dysarthria Severity Assessment

Speech-based cognitive impairment detection offers a noninvasive, accessible alternative to costly biomarker assays, yet transformer-based models remain clinically uninterpretable. We propose a multi-stage explainability framework that translates black-box transformer predictions into clinically grounded narratives by integrating SHapley Additive exPlanations (SHAP)-based token attribution, theory-informed linguistic features, and a four-stage LLM reasoning pipeline using LLaMA-3.1-70B-Instruct. Built on the SpeechCARE-Adaptive Gating Network multimodal screening model (F1 = 72.11% on the NIA PREPARE benchmark), the framework maps model outputs to four cognitive-linguistic dimensions, including lexical richness, syntactic complexity, and semantic coherence. Physician evaluation on 70 stratified English samples demonstrated strong alignment with patient-level cognitive profiles, and a System Usability Scale score of 82/100 indicated high potential for clinical workflow integration.

As deep language models (DLMs) are increasingly deployed in high-stakes domains such as healthcare, understanding their decision rationale becomes paramount for ensuring trust, safety, and accountability. However, achieving this vital level of interpretability is particularly challenging when these DLMs operate as black-box systems (e.g., via APIs), where access to internal model states (e.g., parameters, gradients) is restricted. Despite numerous efforts, existing explanation methods often fail to concurrently satisfy three key desiderata: (i) inference-time efficiency, (ii) black-box compatibility without inducing out-of-distribution behavior, and (iii) comprehensible explanations grounded in the input's linguistic structure. To address these challenges, we propose a method that explains predictions of DLMs by selecting a small, informative subset of input words. We formulate this as an amortized optimization problem, enabling efficient one-shot inference without the need for input-specific search. Our selection policy is trained via REINFORCE-style policy gradients, allowing discrete word selection in a fully gradient-free setting. To enhance interpretability and align with human linguistic intuition, we integrate graph-structured knowledge into this selection process, fostering linguistically coherent subsets that result in explanations both highly informative and cognitively meaningful to end-users. We evaluated our method on diverse DLM architectures and multiple real-world datasets. It consistently identifies word subsets with enhanced discriminative power and stronger alignment with linguistically salient cues, outperforming both conventional black-box compatible methods and gradient-based approaches that are given oracle access to the black-box model's gradients for a more challenging benchmark. Our code is available at here.

Explainable AI (XAI) techniques are increasingly important for the validation and responsible use of modern deep learning models, but are difficult to evaluate due to the lack of good ground-truth to compare against. We propose a framework that serves as a quantifiable metric for the quality of XAI methods, based on continuous input perturbation. Our metric formally considers the sufficiency and necessity of the attributed information to the model's decision-making, and we illustrate a range of cases where it aligns better with human intuitions of explanation quality than do existing metrics. To exploit the properties of this metric, we also propose a novel XAI method, considering the case where we fine-tune a model using a differentiable approximation of the metric as a supervision signal. The result is an adapter module that can be trained on top of any black-box model to output causal explanations of the model's decision process, without degrading model performance. We show that the explanations generated by this method outperform those of competing XAI techniques according to a number of quantifiable metrics.