Gender Associations in LLM-Mediated ADHD Self-Diagnosis

Abstract

Large Language Models (LLMs) are increasingly used for medical self-diagnosis. However, the way demographic cues shape outputs in these interactions remains poorly understood. This is particularly consequential for diagnoses like ADHD, where persistent gender disparities are not fully aligned with the clinical evidence. We adapt the Context Association Test (CAT) to evaluate whether GPT-4o responds to gendered ADHD associations in a zero-shot, self-diagnostic setting. We show that explicit cueing consistently amplifies certain ADHD subtype associations while implicit cueing produces near proxy-aligned distributions. These divergences suggest that explicit demographic cues may activate bias-mitigation mechanisms that over-correct rather than eliminate bias, whereas implicit cues appear to reflect the model's default behavior. Our results demonstrate that evaluating gendered bias in LLM-mediated self-diagnosis requires careful attention to the demographic associations a model encodes.