The sycophancy of large language models can increase the safety risk in intervention dialogue for autistic children. Supervised fine-tuning can somewhat reduce sycophancy, but relying solely on positive examples is often insufficient to identify and correct failure patterns. We observe that sycophancy behaviors can often be localized to a limited span within the model response. In this regime, sequence-level preference optimization can over-update preference-irrelevant tokens and degrade intervention ability. To address this, we propose the \textbf{M}inimal \textbf{E}dit \textbf{D}ata \textbf{A}ugmentation (MEDA) strategy to construct controlled, stable, minimal edit preference pairs and \textbf{T}oken-level \textbf{D}ifference \textbf{D}irect \textbf{P}reference \textbf{O}ptimization (TD-DPO), which upweights difference tokens between chosen and rejected responses while downweighting shared tokens to suppress background drift. Extensive experiments across multiple backbones and evaluators show that TD-DPO achieves a better trade-off between sycophancy mitigation and intervention ability retention in our offline settings, highlighting its potential as a practical alignment approach for autism intervention.
Ran Gu, Benjamin Hou, Mélanie Hébert +5cs.CV cs.CL
Despite strong performance of deep learning models in retinal disease detection, most systems produce static predictions without clinical reasoning or interactive explanation. Recent advances in multimodal large language models (MLLMs) integrate diagnostic predictions with clinically meaningful dialogue to support clinical decision-making and patient counseling. In this study, OcularChat, an MLLM, was fine-tuned from Qwen2.5-VL using simulated patient-physician dialogues to diagnose age-related macular degeneration (AMD) through visual question answering on color fundus photographs (CFPs). A total of 705,850 simulated dialogues paired with 46,167 CFPs were generated to train OcularChat to identify key AMD features and produce reasoned predictions. OcularChat demonstrated strong classification performance in AREDS, achieving accuracies of 0.954, 0.849, and 0.678 for the three diagnostic tasks: advanced AMD, pigmentary abnormalities, and drusen size, significantly outperforming existing MLLMs. On AREDS2, OcularChat remained the top-performing method on all tasks. Across three independent ophthalmologist graders, OcularChat achieved higher mean scores than a strong baseline model for advanced AMD (3.503 vs. 2.833), pigmentary abnormalities (3.272 vs. 2.828), drusen size (3.064 vs. 2.433), and overall impression (2.978 vs. 2.464) on a 5-point clinical grading rubric. Beyond strong objective performance in AMD severity classification, OcularChat demonstrated the ability to provide diagnostic reasoning, clinically relevant explanations, and interactive dialogue, with high performance in subjective ophthalmologist evaluation. These findings suggest that MLLMs may enable accurate, interpretable, and clinically useful image-based diagnosis and classification of AMD.