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Audio models can hear pain in the voice and still answer at chance, because the evidence fades before the answer

AspireAI community · arXiv (Wenqi Li et al.)
Large audio language models process speech directly, but it was unclear how well they use the non-lexical acoustic information speech carries. Using TAME-Pain, which holds pain-neutral Harvard sentences alongside spoken pain ratings recorded at different self-reported levels, the HEAR framework traces pain-related information from the speech signal through to the model's prediction across seven closed-source and open-weight models. On the Harvard sentences, where pain can only come from the voice, every model performed at chance level, and same-speaker references or few-shot examples improved balanced accuracy by no more than six points. On the spoken ratings the same models reached 87.5-99.7% balanced accuracy. Layer-wise probing shows pain decodable from early audio representations at 74.1% balanced accuracy for binary prediction and 45.0% for three-class severity, but that information and most pain-associated acoustic cues decrease in deeper layers. Recovering those cues and reinjecting them as structured text improved pairwise pain prediction by up to 32 points.
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