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

arXiv: https://arxiv.org/abs/2604.26568 · HTML: https://mlsanity.com/paper/2604.26568/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 27 references that are in the map.
- First posted on arXiv 29 Apr 2026.

## Builds on (most cited first, 12 of 12)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Robust Speech Recognition via Large-Scale Weak Supervision](https://mlsanity.com/paper/2212.04356/) (2022)
- [wav2vec 2.0: A Framework for Self-Supervised Learning of Speech Representations](https://mlsanity.com/paper/2006.11477/) (2020)
- [HuBERT: Self-Supervised Speech Representation Learning by Masked Prediction of Hidden Units](https://mlsanity.com/paper/2106.07447/) (2021)
- [WavLM: Large-Scale Self-Supervised Pre-Training for Full Stack Speech Processing](https://mlsanity.com/paper/2110.13900/) (2021)
- [Phi-4-Mini Technical Report: Compact yet Powerful Multimodal Language Models via Mixture-of-LoRAs](https://mlsanity.com/paper/2503.01743/) (2025)
- [UltraSuite: A Repository of Ultrasound and Acoustic Data from Child Speech Therapy Sessions](https://mlsanity.com/paper/1907.00835/) (2019)
- [Automatic Detection of Speech Sound Disorder in Child Speech Using Posterior-based Speaker Representations](https://mlsanity.com/paper/2203.15405/) (2022)
- [Automatic Speech Recognition (ASR) for the Diagnosis of pronunciation of Speech Sound Disorders in Korean children](https://mlsanity.com/paper/2403.08187/) (2024)
- [The Sound of Syntax: Finetuning and Comprehensive Evaluation of Language Models for Speech Pathology](https://mlsanity.com/paper/2509.16765/) (2025)
- [Best Practices and Considerations for Child Speech Corpus Collection and Curation in Educational, Clinical, and Forensic Scenarios](https://mlsanity.com/paper/2507.12870/) (2025)

## Abstract (arXiv)

Speech Sound Disorders (SSD) affect roughly five percent of children, yet speech-language pathologists face severe staffing shortages and unmanageable caseloads. We test a hierarchical approach to SSD classification on the granular multi-task SLPHelmUltraSuitePlus benchmark. We propose a cascading approach from binary classification to type, and symptom classification. By fine-tuning Speech Representation Models (SRM), and using targeted data augmentation we mitigate biases found by previous works, and improve upon all clinical tasks in the benchmark. We also treat Automatic Speech Recognition (ASR) with our data augmentation approach. Our results demonstrate that SRM consistently outperform the LLM-based state-of-the-art across all evaluated tasks by a large margin. We publish our models and code to foster future research.