A Neuroimaging Simulation Framework for Developing and Evaluating Causal AI

Causal generative modeling is essential for developing reliable and transparent AI systems capable of counterfactual reasoning. While existing approaches focus on integrating causal constraints during the training of generative models, they often lack a unified framework to leverage the zero-shot reasoning capabilities of pretrained foundation models. We introduce FM-CGM, a modular framework for end-to-end visual causal reasoning using pretrained foundation models. FM-CGM formalizes the causal pipeline through three core components: a concept extractor, a concept manipulator, and a counterfactual generator. By leveraging a large reasoning model for causal inference and a text-to-image diffusion model for generation, our approach enables zero-shot causal discovery, intervention, and counterfactual generation. We then develop Causal Semantic Guidance (CSG), a cross-attention-based mechanism that ensures semantic interventions propagate to descendant concepts while preserving invariant regions. We empirically show that our approach can identify plausible causal structures and is suitable for faithful counterfactual image generation.

Large Language Models (LLMs) generate realistic synthetic data but offer no guarantee that their outputs respect the causal mechanisms governing the target domain. We introduce CausalSynth, a framework that decouples causal structure generation from semantic realization, yielding synthetic data that is both causally valid and linguistically rich. The framework operates in three phases. First, a Structural Causal Model (SCM) - a tuple of structural equations defined over a directed acyclic graph (DAG) generates causal skeletons, i.e., variable assignments that satisfy the Global Markov Property of the governing DAG, via ancestral sampling. Second, an LLM acts as a constrained \emph{realizer}, a conditional translator that maps each skeleton to a high-dimensional observation such as a clinical note or a transaction log. Third, an Iterative Consistency Verification module detects structural violations through deterministic extraction and feeds targeted corrections back to the LLM, forming a closed-loop refinement process. We identify the Semantic Backdoor problem the systematic tendency of LLMs to override imposed causal facts with pre-training priors -- and prove that our iterative mechanism reduces the resulting selection bias relative to standard rejection sampling. On three causal benchmarks (ASIA, ALARM, and MIMIC-Struct), CausalSynth preserved conditional independencies with false-positive rates near the nominal $α=0.05$ level and achieved realizability rates above 96% with 70B-parameter LLM backbones. The framework additionally supports principled interventional and counterfactual generation through noise retention and graph mutilation.

Synthetic tabular data are often evaluated by distributional similarity, privacy distance, or train-on-synthetic-test-on-real predictive performance, but these criteria do not ensure validity for causal inference. We show that fully generative tabular synthesizers, including GAN- and LLM-based models, can preserve predictive utility while distorting average treatment effect (ATE) estimates. The failure is structural: ATE preservation requires both a realistic covariate law and an accurate treatment-effect contrast, whereas prediction loss penalizes treatment-effect error only through an overlap-weighted term. Thus, under imbalance or limited overlap, a generator may reproduce dominant observed outcomes while underlearning intervention-relevant contrasts. We formalize this mismatch through sensitivity and loss-decomposition results. Motivated by this causal analysis and intuition, we propose a hybrid synthetic-data framework for causal inference that generates covariates while modeling treatment and outcome mechanisms separately. We evaluate the framework in three settings: ATE preservation under fully generative versus hybrid synthesis, augmentation for practical positivity problems, and diagnostic simulation engines for comparing OR, IPW, AIPW, and TMLE before real-data analysis. We also stress-test the hybrid construction across settings that vary overlap, covariate dimension, seed sample size, and treatment-effect complexity, including a logistic outcome-model misspecification check. Across controlled simulation experiments, hybrid synthesis improves causal fidelity relative to fully generative baselines; the ACTG application shows improved predictive fidelity and potential for finite-sample estimator benchmarking. LLM-based hybrid synthesis is often more faithful than CTGAN in settings where causal fidelity can be assessed.