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Freak speak or lingo star? A beginner’s guide to Foreign Accent Syndrome‬

Today’s Daily Telegraph featured the story of Englishman Alun Morgan who following a stroke now speaks fluent Welsh. Doctors diagnosed the 81-year old Mr Morgan with aphasia, a form of brain damage that causes a shift in the brain’s language centre. Mr Morgan is now being taught to speak English again.

Although often treated as a joke, ‘Foreign Accent Syndrome’ (FAS) is a very rare speech disorder but now medically recognized condition. FAS is typically characterized by the (sometimes sudden) appearance of a new speaking accent, identifiably different from the person’s native language. Prior exposure and knowledge to the newly acquired accent is not needed for it to occur and it is usually perceived as foreign or dialectical by fellow natives and, usually, by the person themselves. Published case studies have reported that it is impossible to fake FAS. However, the FAS sufferers don’t suddenly acquire a foreign language (vocabulary, grammar, syntax, etc.) just the accent (although the Wikipedia entry on FAS made reference to a news report that coming out of a coma, a 13-year old Croatian girl allegedly gained the ability to speak fluent German). However, as far I am aware, there are no proven cases where someone with improved their language skills following the development of FAS.

FAS typically occurs following a traumatic brain injury (e.g., head trauma, stroke, cerebral haemorrhage) although other conditions (such as multiple sclerosis) have also led to the development of FAS. Those with FAS often suffer in other ways including poor concentration span, poor memory, and feelings related to loss of identity. Research examining the brain structures of those with FAS have highlighted there are commonalities in relation to specific parts of the brain that are (unsurprisingly areas that control various language functions). More recently, there is growing empirical evidence that the cerebellum (which controls motor function) appears to be critical in the development of some cases of FAS. For instance, Dr. D.A. Cohen and his colleagues published a case study in a 2008 issue of the journal Neurology and concluded that their case demonstrated “that abnormal right cerebellar activity can play a causal role in perpetuating the FAS rather than being merely an epiphenomenon of damage to the reciprocally connected left hemisphere”. A series of papers published by a team led by Dr. P. Mariën have all conformed the role of the cerebellum in the acquisition of FAS (Clinical Neurology and Neurosurgery, 2006; Folia Phoniatrica et Logopaedica, 2007; Cortex, 2009).

The disorder was first described over 100 years ago (in 1907) by Dr. Pierre Marie (a French neurologist). This was followed by a Czech case study published in German by Dr. A Pick in 1919. (Unfortunately, these first two cases were not written in English so I have been unable to gain any details of either of the two cases described)

The first published case study written in English is believed to be one dating back to 1947 by the neurologist Dr. Monrad-Krohn. He described the case of a 30-year old female (Astrid L) from Norway who was hit on the head by shrapnel during a German air raid on Oslo in 1941. The injury led to aphasia, hemiplegia, and seizure disorder. This caused speech problems but within a year of the injury, the woman’s speech began to improve but it was different to how she had spoken before her head injury. Monrad-Krohn described how the woman’s ‘rhythm and melody’ of her voice had dramatically altered and that she sounded like she had a foreign (German sounding) accent (even though she had never travelled outside of Norway). Consequently, she was shunned and/or ridiculed by many of her native Norwegians. Since these three early published case studies, around 60 cases of FAS have been documented worldwide including people who went from speaking British to French, American to British, Japanese to Korean, and Spanish to Hungarian. A 2006 article by Diane Garst and William Katz highlighted the common features of FAS. The ‘classic’ characteristics are:

  • Monolingual patient is frequently mistaken for being a non-native speaker.
  • Speech changes are not triggered by psychiatric or psychological problems.
  • Idiosyncratic speech errors contribute to appearance of a cohesive ‘accent’
  • Patient is aware of accent and unhappy about it.
  • Voicing changes occur in both prosody (syllable-by-syllable timing, and abnormal pitch patterns) and segmentals (consonant distortions, substitutions, deletions; frequent problems with alveolar tap/flap; omplex or unusual vowel substitutions)

Writing in a 2007 issue of the Annals of General Psychiatry, Stéphane Poulin and colleagues noted that:

Different explanations of the functional origin of FAS have been suggested, one of the more frequent being impaired access to verbal-motor patterns or a mild form of apraxia of speech. Clinical manifestations are heterogeneous among FAS patients but usually include segmental (e.g., changes in vowel length and tenseness) and prosodic (e.g., inappropriate word and sentence stress) deficits”.

A 2005 paper in the journal European Neurology by Edwards, Patel and Pople examined 35 case published case studies of FAS. Their analysis reported that the majority (n=26) of those with FAS resulted from cerebral infarct. The remainder resulted from head injury (n=6), multiple sclerosis (n=2) and psychosis (n=1). In one-third of the cases (34%), the person with FAS also had agrammatism (i.e., a form of expressive aphasia that refers to the inability to speak in a grammatically correct way). As Stéphane Poulin and colleagues note:

“In spontaneous speech, agrammatic patients speak non-fluently and produce telegraphic speech. They mainly use content words (nouns, verbs, adjectives) and tend to omit or substitute function words (prepositions, articles and auxiliaries) as well as inflections or other grammatical morphemes. Among reported FAS cases, few brain imaging studies have been done and there is no consensus regarding the precise region responsible for its occurrence. Neuroanatomically, the vast majority of the lesions described were in the dominant hemisphere and in most cases involved regions typically associated with Broca’s aphasia. Subcortical structures seem to be consistently affected”.

Thanks to the internet and broadcast media, there are many cases of FAS that have not been reported in the academic and clinical literature. I’ll leave you with a few you can check out yourself. Just click on each name to get the details.

  • Tiffany Roberts: In 1999, 57-year old American woman Tiffany Roberts (from Indiana) had a stroke and developed an English accent.
  • Linda Walker: In 2006, a 60-year old British woman with a Geordie accent (from Newcastle) had a stroke and developed a strange accent (described as Jamaican, Italian, French Canadian and Slovak).
  • Rajesh: In 2007, a 14-year old Indian boy (from Uttar Pradesh) developed a broken American accent following corporal punishment from his father.
  • Cindy Lou Romberg: In 2007, a middle aged American woman Cindy Lou Romberg (from Port Angeles, Washington) developed an English speaking Russian/German/French-sounding accent following her neck being adjusted by a chiropractor (although she had suffered a brain injury in a car crash back in 1991).
  • Julie Frazier: In 2008, a 39-year old American woman Julie Frazier (from Fort Wayne, Indiana) developed a British-Russian accent following a severe hemiplegic migraine (the first such case involving migraine as the trigger episode).
  • Sarah Colwill: In 2010, a 35-year old British woman Sarah Colwill (from Devon) developed a Chinese accent following an extreme migraine.
  • Kay Russell: In 2010, a 49-year old British woman Kay Russell (from Gloucestershire) developed a French/Russian/Eastern European accent following a migraine.
  • Karen Butler: In 2011, a middle-aged American woman Karen Butler (from Newport, Oregon) developed an Irish/Eastern European accent following oral surgery.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ardila, A. Rosselli, M., & O. Ardila. (1988) Foreign accent: an aphasic epiphonomenon? Aphasiology, 2,5, 493-499.

Aronson, A.E. (1990). Dysprosody of pseudo-foreign dialect. In Aronson, A.E. (Ed.), (2nd ed.) Clinical Voice Disorders  (pp. 119-124) New York: Thieme-Stratton.

Berthier, M., Ruiz, A., Massone, M., Starkstein, S., & R. Leiguarda. (1991). Foreign accent syndrome: behavioural and anatomical findings in recovered and non-recovered patients. Aphasiology, 5, 129-147.

Blumstein, S.E., Alexander, M.P., Ryalls, J.H., & W. Katz. (1987). On the nature of the foreign accent syndrome: A case study. Brain and Language, 31,215-244.

Coelho, C.A., & Robb, M.P. (2001). Acoustic analysis of Foreign Accent Syndrome: An examination of three explanatory models. Journal of Medical Speech-Language Pathology, 9, 227-242.

Cohen, D.A., Kurowski, K., Steven, M.S., Blumstein, S.E. & Pascual-Leone, A. (2008). Paradoxical facilitation: the resolution of foreign accent syndrome after cerebellar stroke. Neurology, 73, 566-567.

Edwards, R.J., Patel, N.K. & Pople, I.K. (2005). Foreign accent following brain injury: syndrome or epiphenomenon? European Neurology, 53, 87-91.

Garst, D. & Katz, W. (2006). Foreign Accent Syndrome. The ASHA Leader, August 15.

Marie P. (1907). Presentation de malades atteints d’anarthrie par lesion de l’hemisphere gauche du cerveau. Bulletins et Memoires Societe Medicale des Hopitaux de Paris, 1, 158–160.

Mariën P., Verhoeven J. (2007). Cerebellar involvement in motor speech planning: some further evidence from foreign accent syndrome. Folia Phoniatrica et Logopaedica, 59, 210-217.

Mariën P., Verhoeven J., Engelborghs, S., Rooker, S., Pickut, B. A., De Deyn, P.P. (2006). A role for the cerebellum in motor speech planning: evidence from foreign accent syndrome. Clinical Neurology and Neurosurgery, 108, 518-522.

Mariën, P., Verhoeven, J., Wackenier, P., Engelborghs, S. & De Deyn, P.P. (2009). Foreign accent syndrome as a developmental motor speech disorder. Cortex, 45, 870–878.

Moen, I. (2000). Foreign accent syndrome: A review of contemporary explanations. Aphasiology, 14, 5-15.

Monrad-Krohn, G.H. (1947). Dysprosody or altered “melody of language.” Brain, 70, 405-415.

Pick, A. (1919). Über Änderungen des Sprachcharakters als Begleiterscheinung aphasicher Störungen. Zeitschrift für gesamte Neurologie und Psychiatrie, 45, 230–241.