Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, and its diagnosis relies on assessments combining clinician judgment with standardized rating scales and reports from parents and teachers. While structured instruments such as the Conners’ Teacher Rating Scale–Revised Short Form (CTRS-R:S) quantify ADHD-related behaviors, teachers also provide open-ended narratives that may contain complementary signals not captured by structured assessments. However, it remains unclear to what extent teacher narratives encode signals overlooked by rating scales. In this study, we analyze de-identified Turkish teacher evaluation forms collected during clinical ADHD assessments, including both CTRS-R:S scores and open-ended teacher narratives. We compare predictive signals from structured scores and narrative text and identify cases where structured assessments fail to clearly distinguish ADHD from non-ADHD students while narrative-based models capture distinct behavioral patterns. Notably, these cases show minimal overlap with those missed by the narrative model, suggesting that structured and narrative information encode complementary signals. To interpret these differences, we apply a large language model (LLM)-assisted theme discovery pipeline that reveals distinct attention, behavioral, and family-related patterns, highlighting the potential of natural language processing (NLP) to uncover clinically relevant signals from teacher narratives and to complement traditional ADHD screening tools.

Contemporary NLP has rapidly progressed from feature-based classification to fine-tuning and prompt-based techniques leveraging large language models. Many of these techniques remain understudied in the context of real-world, clinically enriched spontaneous dialogue. We fill this gap by systematically testing the efficacy and overall performance of a wide variety of NLP techniques ranging from feature-based to in-context learning on transcribed speech collected from patients with bipolar disorder, schizophrenia, and healthy controls taking a focused, clinically-validated language test. We observe impressive utility of a range of feature-based and language modeling techniques, finding that these approaches may provide a plethora of information capable of upholding clinical truths about these subjects. Building upon this, we establish pathways for future research directions in automated detection and understanding of psychiatric conditions.