Medically reviewed by Timothy J. Legg, Ph.D., CRNP — Written by Tim Jewell on June 14, 2019
- When to get help
- Bottom line
Foreign accent syndrome (FAS) happens when you suddenly start to speak with a different accent. It’s most common after a head injury, stroke, or some other type of damage to the brain.
Although it’s extremely rare, it’s a real condition. Only about 100 people have been diagnosed with this condition since the first known case came to light in 1907.
Some examples of FAS include an Australian woman who developed a French-sounding accent after a car accident. In 2018, an American woman in Arizona woke up one day with a mixture of Australian, British, and Irish accents after falling asleep the night before with a headache.
It doesn’t just affect English speakers. FAS can happen to anyone and has been documented in cases and languages all over the world.
Let’s look into what causes it, how to recognize the symptoms, and what to do about it.
FAS seems to be related to conditions that affect and damage the Broca’s area of the brain. This area, on the left side of the brain, is typically linked to producing speech.
Conditions that can affect this area of the brain include:
Your natural accent results from a system of sound patterns in your native language that you unconsciously learn as you grow up. This is known as the phonetic system.
Your accent can change early in life as you’re exposed to different accents and speech patterns. But after your teenage years, your phonetic system stays mostly fixed.
That’s what makes FAS so puzzling. Its symptoms affect the entire patterning of your phonetic system. Here’s how it can show up in your speech:
Explainer: what is foreign accent syndrome?
In the past few days, a great deal of media attention has been paid to Leanne Rowe, a Tasmanian woman who has lived eight years with a French accent she acquired after a car accident. This phenomenon is known as foreign accent syndrome, a rare disorder that usually arises after brain damage as a result of, for example, stroke or head injury.
Foreign accent syndrome has always been the source of much media interest and the stories often sound sensational. There has been, for example, an American who spoke with a British accent, a British Yorkshireman with an Irish accent and another British man with a Russian accent.
More spectacular are tales of people waking from strokes or comas speaking fluently in languages they hardly knew before. While there is no scientific verification of cases of speaking a new language, speaking with a foreign accent is well documented, as shown in the video below.
This is not just an English phenomenon – one of the first cases was of a Norwegian woman who suffered brain damage as the result of being hit by bomb shrapnel during an air raid in World War II. She acquired a German accent and was subsequently shunned by friends and neighbours who thought she was a German spy.
It is obvious how in this case the change of accent can have distressing consequences. But even in less extreme cases, the change in perceived identity can be hard to cope with, as Ms Rowe reports. However, better understanding of the cause of the problem often helps the sufferer and those around them.
What causes foreign accent syndrome?
Foreign accent syndrome is caused by brain damage which impairs the control of the muscles used to produce speech.
Foreign Accent Syndrome, a Rare Presentation of Schizophrenia in a 34-Year-Old African American Female: A Case Report and Literature Review
Foreign Accent Syndrome (FAS) is a rare phenomenon where speech is characterized by a new accent to the patient’s native language. More than 100 cases with the syndrome have been published, the majority of which were associated with observed insults of the speech center.
Some other cases have been described without identifiable organic brain injury, especially in patients with psychiatric illness. This paper presents a patient with schizophrenia and FAS, without any evidence of organic brain injury. FAS recurred during psychotic exacerbation and did not reverse before transfer to a long-term psychiatric facility.
The case is discussed in the context of a brief review of the syndrome.
Foreign Accent Syndrome (FAS) is a rare condition where speech is characterized by a new accent to the patient’s native language. This new accent is foreign to both the speaker and the listener [1–4]. It is important to note that the affected patient may never have lived in the country of origin of the new accent [1–4].
There is evidence from the medical literature to suggest that there are three main types of FAS: neurogenic, psychogenic, and mixed. Each of these variants has unique characteristics [5, 6]. There has been an increase in the number of reported FAS cases especially of the neurogenic variety .
The patient presented here had a known schizophrenia and psychogenic FAS, a combination for which only few cases have been reported to date in the medical literature.
2. Case Report
The patient was a 34-year-old African American US-born single female. At the time of the investigation she was unemployed and lived temporarily with her mother, who had a history of paranoid schizophrenia. The patient was brought to the psychiatry emergency room by ambulance for evaluation of aggression.
Upon presentation, the patient described an altercation with her mother’s landlady, hitting her numerous times in the face with a closed fist. The patient started the altercation because she felt that the landlady practiced voodoo and had cursed her, causing her hair to fall off. She described an overwhelming rage prior to the physical assault.
The patient did not show any remorse for her actions: “I hate her,” “I did the right things,” and “She is evil” are examples of statements made by the patient. Collateral information from the patient’s mother revealed that the patient had not been compliant with her medications.
She refused to follow up with outpatient care after the last inpatient admission ten months previously. The patient denied auditory hallucinations but appeared to be internally preoccupied. She denied visual and tactile hallucinations, thought insertion, and thought broadcasting. She reported an unchanged pattern of sleep and appetite, which she described to be “good.
” Prior to this episode, the patient had been under economic and emotional stress. She lost her job as a nurse aide five months earlier and had not been able to secure another job since then. The patient broke up with her fiancée ten months previously after cutting her fiancée’s stepfather’s face following verbal altercation.
There was no symptom suggestive of mania, seizure disorder, head trauma, loss of consciousness, cerebrovascular accident, Parkinson’s disease, anxiety, or other organic brain disorder. The patient denied use of nicotine, alcohol, and other psychoactive substances currently or in the past.
The patient had her first inpatient psychiatry admission for acute exacerbation of paranoid schizophrenia and FAS ten months earlier. She was then treated with risperidone tablets with improvement including change in accent on discharge, when she was less psychotic.
The patient had a family history of sickle cell disease (brother had sickle cell disease) and schizophrenia (brother, mother, and uncle had schizophrenia). Birth and developmental history were unremarkable. There were no reported behavioral or learning disabilities, and the patient denied being a victim of emotional, physical, or sexual abuse. She had some college education and worked as a nurse aide up till five months prior to presentation to the hospital.
Mental status examination showed a middle-aged, well-groomed, dark-haired woman with poor eye contact and in no apparent distress. The patient was tangential and preoccupied with “voodoo” and was deeply paranoid of her neighbors and her mother’s landlady.
Auditory hallucinations were not elicited, and she denied suicidal ideation at the time of evaluation. The patient continued to endorse homicidal ideation towards her mother’s landlady. She was awake, alert, orientated in time, place, and person, and attentive and had good concentration but had poor impulse control.
Her insight and judgment were impaired. Immediate recall and short- and long-term memory were intact.
The physical examination of the patient showed no significant pathological findings. Laboratory investigations were unremarkable. Electroencephalogram showed no seizure activity. Structural magnetic resonance imaging (MRI) and MR angiography of the head were both unremarkable.
Foreign Accent Syndrome
During a German air raid over Oslo in 1941, shrapnel struck a 30-year-old native Norwegian woman on the left side of her head. The damage caused right-sided hemiplegia, Broca’s type aphasia, and a seizure disorder.
Within a year, her language improved but her speech had an altered rhythm and melody suggesting a foreign accent (although she had never traveled outside of the country). The respected neurologist Monrad-Krohn described this incident in a detailed 1947 case report.
The study is one of the most frequently referenced cases of what is now referred to as “foreign accent syndrome” (FAS). Since this famous case, approximately 40 individuals with FAS have been described in world literature.
Reported accent changes include Japanese to Korean, British-English to French, American-English to British-English, and even Spanish to Hungarian.
The concept that a foreign-sounding accent may emerge after brain damage has puzzled both the public and the medical community.
A few high-profile news reports have recently aired on American TV, but there remains a “gee-whiz” quality to this rare disorder.
FAS is only briefly mentioned in motor speech textbooks and is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, IV. As one of our recent patients remarked, “No one knows about it, so no one helps.”
FAS is often caused by a stroke, although traumatic brain injury or multiple lesions can also lead to this disorder. FAS can be of unknown etiology, and multiple sclerosis has been listed as a possible factor in a reported case.
Stroke-related damage usually occurs within a network of brain structures associated with speech production, including the left-hemisphere Broca’s area, pre-motor and motor areas, and the basal ganglia.
However, at least two reports describe FAS associated damage to the right-hemisphere, a part of the brain known to play a role in speech prosody.
As the name suggests, FAS is the sudden and unexpected appearance of a seemingly “foreign” accent. Although some features of FAS speech may resemble those of other neurogenic disorders (e.g.
aphasia, dysarthria, and apraxia of speech), patients with FAS do not usually sound pathological to the average listener. Instead, they are commonly perceived as non-native English speakers.
For instance, one of our patients, a native New Yorker, was so often mistaken for being Swedish that her doctor jokingly suggested she call herself “Olga.”
Each case of FAS presents uniquely, but most cases share a core set of prosodic and segmental changes (see Moen, 2000, for details). For each patient, errors seem fairly predictable, giving the sense of a consistent “accent.
” The typical patient has good comprehension, but notably altered speech production. Prosody is impaired at the word and sentence level, and there is usually a tendency toward “isochrony” (equal and excessive stress at the syllable level).
However, there are reports of more fluent individuals with FAS who present with relatively preserved global prosody (sentence level intonation).
Segmental changes are those that affect individual consonants and vowels. For individuals with FAS, consonants may be altered, substituted, or deleted. Voicing changes also occur. Complex clusters may present particular difficulty.
For American-English speakers with FAS, a hallmark symptom appears to be difficulty realizing the alveolar tap/flap following a stressed syllable. Instead, patients may produce equally stressed syllables with an intervening stop (e.g.
Vowel changes include distortion, prolongations, and substitutions. FAS vowel substitutions have particularly puzzled researchers. For instance, one of the subjects we have observed frequently substitutes the low back vowel /α/ for the target vowel /ε/, a mid-front vowel.
Thus, “yeah” is pronounced “yah” (/jα/), contributing to the impression of a Swedish accent. This type of sound substitution is quite different from those of individuals with aphasia or apraxia of speech (in which a substituted sound is typically one phonetic feature away from its intended target).
Nevertheless, individuals with FAS also insert epenthetic vowels into blends (e.g., realizing “strike” as
), a pattern also observed in apraxia of speech (AOS).
Adding to the mysterious nature of the disorder, evidence suggests that although some cases evolve, many do not. A few documented FAS cases have completely resolved within two months without therapeutic intervention.
The evolving quality prompted Berthier and colleagues (1991) to follow recovery in four cases with varied lesion size and location.
Of the four subjects studied, two with relatively small lesions in the premotor cortex, an area known for its role in speech prosody, showed gradual improvement over two months. The other two subjects had substantial damage to the precentral gyrus, an articulation area.
These individuals had cases that persisted more than a year. These data suggest a potential effect of lesion size. Functional brain imaging will play an important future role in delineating both the brain states responsible for FAS and for its recovery.
A team of professionals should collaborate in the diagnosis of suspected FAS.
An ideal team would include a speech-language pathologist, a neurologist for medical management, a radiologist to interpret brain computed tomography or magnetic resonance imaging, a neuropsychologist to evaluate cognitive function, and a clinical psychologist to aid in vocational, social, and familial adjustments.
Foreign accent syndrome: Symptoms, causes, treatment, and more
A person with foreign accent syndrome may speak with an accent of someone from a different country or region.
With this condition, a person who is a native language speaker may also begin sounding like someone who speaks the language as a second or third language.
In most cases, an injury to the central nervous system causes foreign accent syndrome. However, a variant of this diagnosis called psychogenic foreign accent syndrome causes a person to speak with a foreign accent for psychological, not physiological, reasons.
Foreign accent syndrome is different to when a person spends a significant amount of time in another country and develops an accent.
People with foreign accent syndrome are not faking. Rather, changes in their nervous system — or, in the case of psychogenic foreign accent syndrome, their mental health — cause them to speak differently.
Keep reading to learn more about this rare neurological condition.
Share on PinterestA history of head or facial injuries is a possible cause of foreign accent syndrome.
Foreign accent syndrome causes a person to speak in their usual language but with a foreign accent. The accent remains relatively consistent over time and is not something the person is “faking.”
People with foreign accent syndrome usually have brain damage or a neurological condition, though some have mental health conditions.
People with foreign accent syndrome may not perfectly replicate the accent their speech resembles. However, the changes in their speech tend to remain fairly consistent. People do not typically switch between accents or have an accent only sometimes.
A 2019 report on 49 people with foreign accent syndrome found that most reported having a foreign accent for 2 months to 18 years, with a mean length of 3 years.
Foreign accent syndrome is very rare. In fact, one 2018 analysis estimates that as few as 80 people worldwide have the condition.
For this reason, doctors often study people who present with this symptom and then publish the results. Some published cases are below:
- One of the earliest cases involved a Norwegian woman who was hit with shrapnel during World War II. The German accent she developed due to brain damage caused people to ostracize her.
- A 2016 case report details the story of a 34-year-old African American woman whose doctors related her foreign accent syndrome to schizophrenia. She showed up in the emergency room (ER) with a British accent, despite never having lived in Britain. She had faced immense financial and emotional distress in the months before this visit to ER, and doctors diagnosed her with schizophrenia.
- According to a 2018 case report, a 65-year-old Spanish-speaking woman with multiple sclerosis (MS) began speaking in Spanish with an English accent. MS destroys the myelin that coats the nerves, disrupting their ability to send signals. MRI scans revealed demyelination in her brain.
- According to a 2011 National Public Radio story, an American English-speaking woman developed a foreign accent following dental surgery. The story reports an accent that sounded both Irish and British. The woman reports developing the accent immediately upon waking from surgery. The change persisted even after the swelling in her mouth healed and she recovered from surgery.
Foreign accent syndrome has two main causes: neurological conditions or damage and mental health conditions.
The following sections will discuss these in more detail.
Neurological conditions or damage
Most people with foreign accent syndrome have a neurological condition or a history of head or facial injuries. Some factors that might cause foreign accent syndrome include:
- a blow to the head or face
- surgery to the face or brain
- brain tumors
A 2019 analysis of 49 people with foreign accent syndrome found that the most common linked conditions were:
- severe headaches or migraine (15 people)
- stroke (12 people)
- surgery to the face or mouth (6 people)
- seizures (5 people)
Injuries to the brain from falls, cancer, and other factors may change the way the brain processes language, as well as the way it controls speech.
Mental health conditions
Some people with foreign accent syndrome have mental health conditions such as schizophrenia, depression, or a history of severe trauma.
Some have a conversion disorder. This occurs when a person experiences intense psychological pain that manifests as physical symptoms.
The primary symptom of foreign accent syndrome is speaking in an accent associated with a country where the person has never lived or a language they have never spoken.
For example, a native English speaker who has never left the United States may begin speaking English with a Spanish accent.
Most people with foreign accent syndrome also show symptoms of a psychological or neurological condition. They might have schizophrenia or depression, a recent brain injury, or a medical condition, such as MS or dementia, that damages the brain.
A person whose foreign accent changes slightly or who develops a new accent after living abroad does not have foreign accent syndrome.
A person with foreign accent syndrome may seek treatment because they or someone they know noticed the change in their speech.
In some cases, however, foreign accent syndrome presents secondary to another symptom. In this scenario, a person seeking emergency psychiatric care might also have an unusual accent, or a head injury survivor may develop a new speech pattern.
No specific test can assess for foreign accent syndrome. Instead, doctors work to diagnose the cause using a variety of tests, including:
- blood tests, to test for infections and some illnesses
- brain scans, such as MRI scans, to look for lesions or damage in the brain
- a lumbar puncture, to test for infections in the spinal fluid and to check for signs of certain central nervous system conditions
- a complete medical history, to determine when the symptoms appeared and what may have caused them
- psychiatric screenings, such as assessments for depression and schizophrenia
If a doctor cannot find a physiological cause, they will usually diagnose a person with psychogenic foreign accent syndrome and work to identify a possible psychological cause.
Foreign accent syndrome itself is not dangerous. However, it may warn of a serious medical condition, such as a tumor or lesion in the brain, dementia, or MS. Treatment will therefore focus on addressing the cause of the foreign accent syndrome.
A doctor might prescribe medication for conditions such as MS or surgery for certain brain growths. When there is a psychiatric cause, a doctor may recommend therapy, medication, or both.
Many causes of foreign accent syndrome are not curable, though medication can help manage the symptoms.
In most cases, a doctor will recommend speech therapy to help a person regain their normal habits. When the cause of foreign accent syndrome is unclear — such as in the case of the woman who developed it following dental surgery — speech therapy may be the only treatment option.
- Foreign accent syndrome is a very rare condition.
- The cause is usually neuroglial damage (from trauma), a neurological condition, or a mental health condition.
- Ignoring an unexplained foreign accent might mean delaying treatment for a serious medical condition.
- Anyone experiencing a sudden and unexplainable change in accent should seek the advice of a healthcare professional.
Foreign accent syndrome
Foreign accent syndromeSpecialtyPsychiatry, Neurology
Foreign accent syndrome is a medical condition in which patients develop speech patterns that are perceived as a foreign accent that is different from their native accent, without having acquired it in the perceived accent's place of origin.
Foreign accent syndrome usually results from a stroke, but can also develop from head trauma, migraines or developmental problems.
 The condition might occur due to lesions in the speech production network of the brain, or may also be considered a neuropsychiatric condition.
 The condition was first reported in 1907, and between 1941 and 2009 there were 62 recorded cases.
Its symptoms result from distorted articulatory planning and coordination processes and although popular news articles commonly attempt to identify the closest regional accent, speakers suffering from foreign accent syndrome acquire neither a specific foreign accent nor any additional fluency in a foreign language. Despite an unconfirmed news report in 2010 that a Croatian speaker had gained the ability to speak fluent German after emergence from a coma, there has been no verified case where a patient's foreign language skills have improved after a brain injury.
Signs and symptoms
To the untrained ear, those with the syndrome sound as though they speak their native languages with a foreign accent; for example, an American native speaker of English might sound as though he spoke with a south-eastern English accent, or a native English speaker from Britain might speak with a New York American accent.
However, researchers at Oxford University have found that certain specific parts of the brain were injured in some foreign accent syndrome cases, indicating that particular parts of the brain control various linguistic functions, and damage could result in altered pitch and/or mispronounced syllables, causing speech patterns to be distorted in a non-specific manner.
 Contrary to popular beliefs that individuals with FAS exhibit their accent without any effort, these individuals feel as if they are suffering from a speech disorder.
 More recently, there is mounting evidence that the cerebellum, which controls motor function, may be crucially involved in some cases of foreign accent syndrome, reinforcing the notion that speech pattern alteration is mechanical, and thus non-specific.
The Curious Foreign Accent Syndrome
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“Foreign Accent Syndrome” (FAS) is a rare disorder in which patients start to speak with a foreign or regional tone. This striking condition is often associated with brain damage, such as stroke. Presumably, the lesion affects the neural pathways by which the brain controls the tongue and vocal cords, thus producing a strange sounding speech.
Yet there may be more to FAS than meets the eye (or ear). According to a new paperin the Journal of Neurology, Neurosurgery and Psychiatry, many or even most cases of FAS are ‘functional’, meaning that the cause of the symptoms lies in psychological processes rather than a brain lesion.
To reach this conclusion, authors Laura McWhirter and colleagues recruited 49 self-described FAS suffers from two online communities to participate in a study. All were English-speaking. The most common reported foreign accents were Italian (12 cases), Eastern European (11), French (8) and German (7), but more obscure accents were also reported including Dutch, Nigerian, and Croatian.
Participants submitted a recording of their voice for assessment by speech experts, as well as answering questions about their symptoms, other health conditions, and personal situation. McWhirter et al. classified 35 of the 49 patients (71%) as having ‘probably functional’ FAS, while only 10/49 (20%) were said to probably have a neurological basis, with the rest unclear.
These classifications are somewhat subjective in that there are no hard-and-fast criteria for functional FAS. None of the ‘functional’ cases reported hard evidence of neurological damage from a brain scan, but only 50% of the ‘neurological’ cases did report such evidence. The presence of other ‘functional’ symptoms such as irritable bowel syndrome (IBS) was higher in the ‘functional’ group.
In terms of the characteristics of the foreign accents, patients with a presumed functional origin often presented with speech patterns that showed inconsistency or variability. For instance, pronouncing ‘cookie jar’ as ‘tutty dar’ but being able to correctly produce ‘j’, /k/, /g/ and ‘sh’ sounds as part of other words.
But if FAS is often a psychological disorder, what is the psychology behind it? McWhirtner et al. don’t get into this, but it is interesting to note that FAS is often a media-friendly condition. In recent years there have been many news stories dedicated to individual FAS cases. To take just three:
American beauty queen with Foreign Accent Syndrome sounds IRISH, AUSTRALIAN and BRITISH
Scouse mum regains speech after stroke – but is shocked when her accent turns Russian
Traumatic car accident victim has Irish accent after suffering severe brain injury