What Is Foreign Accent Syndrome?

One night in 2016, Michelle Myers—an Arizona mom with a history of migraines—went to sleep with a splitting headache. When she awoke, her speech was marked with what sounded like an British accent, despite having never left the U.S. Myers is one of about 100 people worldwide who have been diagnosed with Foreign Accent Syndrome (FAS), a condition in which people spontaneously speak with a non-native accent.

In most cases, FAS occurs following a head injury or stroke that damages parts of the brain associated with speech. A number of recent incidences of FAS have been well documented: A Tasmanian woman named Leanne Rowe began speaking with a French-sounding accent after recovering from a serious car accident, while Kath Lockett, a British woman, underwent treatment for a brain tumor and ended up speaking with an accent that sounds somewhere between French and Italian.

The first case of the then-unnamed syndrome was reported in 1907 when a Paris-born-and-raised man who suffered a brain hemorrhage woke up speaking with an Alsatian accent. During World War II, neurologist Georg Herman Monrad-Krohn compiled the first comprehensive case study of the syndrome in a Norwegian woman named Astrid L., who had been hit on the head with shrapnel and subsequently spoke with a pronounced German-sounding accent. Monrad-Krohn called her speech disorder dysprosody: her choice of words and sentence construction, and even her singing ability, were all normal, but her intonation, pronunciation, and stress on syllables (known as prosody) had changed.

In a 1982 paper, neurolinguist Harry Whitaker coined the term "foreign accent syndrome" for acquired accent deviation after a brain injury. Based on Monrad-Kohn's and other case studies, Whitaker suggested four criteria for diagnosing FAS [PDF]:

"The accent is considered by the patient, by acquaintances, and by the investigator to sound foreign. It is unlike the patient’s native dialect before the cerebral insult. It is clearly related to central nervous system damage (as opposed to a hysteric reaction, if such exist). There is no evidence in the patient’s background of being a speaker of a foreign language (i.e., this is not like cases of polyglot aphasia)."

Not every person with FAS meets all four criteria. In the last decade, researchers have also found patients with psychogenic FAS, which likely stems from psychological conditions such as schizophrenia rather than a physical brain injury. This form comprises fewer than 10 percent of known FAS cases and is usually temporary, whereas neurogenic FAS is typically permanent.

WHAT’S REALLY HAPPENING?

While scientists are not sure why certain brain injuries or psychiatric problems give rise to FAS, they believe that people with FAS are not actually speaking in a foreign accent. Instead, their neurological damage impairs their ability to make subtle muscle movements in the jaw, tongue, lips, and larynx, which results in pronunciation that mimics the sound of a recognizable accent.

"Vowels are particularly susceptible: Which vowel you say depends on where your tongue is in your mouth," Lyndsey Nickels, a professor of cognitive science at Australia's Macquarie University, wrote in The Conversation. "There may be too much or too little muscle tension and therefore they may 'undershoot' or 'overshoot' their target. This leads to the vowels sounding different, and sometimes they may sound like a different accent."

In Foreign Accent Syndromes: The Stories People Have to Tell, authors Nick Miller and Jack Ryalls suggest that FAS could be one stage in a multi-phase recovery from a more severe speech disorder, such as aphasia—an inability to speak or understand speech that results from brain damage.

People with FAS also show wide variability in their ability to pronounce sounds, choose words, or stress the right syllables. The accent can be strong or mild. Different listeners may hear different accents from the speaker with FAS (Lockett has said people have asked her if she's Polish, Russian, or French).

According to Miller and Ryalls, few studies have been published about speech therapy for treating FAS, and there's no real evidence that speech therapy makes a difference for people with the syndrome. More research is needed to determine if advanced techniques like electromagnetic articulography—visual feedback showing tiny movements of the tongue—could help those with FAS regain their original speaking manner.

Today, one of the pressing questions for neurologists is understanding how the brain recovers after injury. For that purpose, Miller and Ryalls write that "FAS offers a fascinating and potentially fruitful forum for gaining greater insights into understanding the human brain and the speech processes that define our species."

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