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Below are before and after videos
of a woman with Foreign Accent Syndrome (FAS):
Female without FAS
Female with FAS
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Frequently Asked Questions
By Professor Jack Ryalls and Graduate Student Rosalie Perkins, Department of Communication Sciences and Disorders
Click here for a large-print version of this text. Question: What is FAS? Foreign accent syndrome (FAS) is a rare neurological speech disorder which usually results from a severe head injury or stroke. FAS is not a disease, but
rather a secondary symptom of a neurological disorder. In most cases, the damage occurs in the cortical or subcortical structures in the left hemisphere of the brain
that are typically associated with speech production
(i.e., Broca’s area, motor and pre-motor cortices, and the basal ganglia). As a result, patients with FAS produce speech characteristics atypical for their native language or dialect. Family, friends and other members of their community perceive these changes in speech patterns as a foreign accent, hence the term “foreign accent syndrome.”
Whitaker (1982), who first proposed the term “foreign accent syndrome,” identified the following features for FAS: • the accent is considered by the patient and by the investigator or listener to sound foreign,
• the accent is unlike the patient’s native dialect before cerebral insult,
• the accent is clearly related to central nervous system damage, and
• there is no evidence in the patient’s background of being a speaker of a foreign language For some cases, there may be general agreement about what country the person’s accent seems to originate from. However, for many cases there may be no consensus about the accent’s origin. Some researchers feel that the perceived accent varies according to the linguistic sophistication of the listener, and that FAS may largely be a perceptual epiphenomenon ("in the ear of the beholder," Blumstein, Alexander, Ryalls, Katz & Dworetzky, 1987). The accent may change over time, so the FAS patients’ speech patterns move ‘from one country to another’, and some individuals with FAS report that their accent is more pronounced during periods of greater emotional stress. Although there is a wide variety of perceived accents, there seems to be two general accent types for speakers of American English: "Scandinavian" and "Eastern European." FAS is typically diagnosed through the collaborative efforts of several medical professionals, including neurologists, neuropsychologists, speech-language pathologists (SLP) and clinical psychologists (Garst & Katz, 2006). An important step in differential diagnosis is to identify the accent as a problem of motor speech output due to neurological damage, rather than one of psychological or psychiatric origin. A battery of tests designed to rule out other speech/language disorders (e.g., dysarthria, apraxia, aphasia, etc.) should be administered by an appropriate professional, such as a licensed SLP. In some rare cases, brain imaging results of FAS patients do not reveal specific areas of neurological damage. However, this does not necessarily indicate damage is not present. Newer brain imaging techniques, such as diffusion tensor imaging (DTI), hold promise for greater accuracy in identifying the site of neurological damage (Fridriksson, Ryalls, Rorden, Morgan, George & Baylis, 2005).
No, apparently FAS (or very similar symptoms) can result from other neurological disorders such as Multiple Sclerosis and Dystonia, for example. Although ataxic dysarthric can also result in speech differences which may sound “foreign,” we believe they are distinct from those observed in Foreign Accent Syndrome. Specific acoustic comparisons of the two would be useful in further distinguishing their characteristics.
No, according to the definition of FAS above, FAS cannot be the result of a psychiatric disorder. Scientific articles on psychogenic or psychiatric bases for Foreign Accent Syndrome (especially in Europe) have made this appear to be the case. However, an apparently unlearned foreign accent can result from non-neurological basis. In other words, similar symptoms to FAS may be the manifestation of a psychiatric disorder. But this disorder cannot be “Foreign Accent Syndrome” according to its definition above, which states that the accent must clearly be the result of neurological damage. : Although there are no published cases, to our knowledge, of Foreign Accent Syndrome in children, anecdotal reports from parents and personal communication of a case study (Croot, 2007) suggest that FAS can occur in children. This is an issue that warrants additional scientific attention. However, as is well-known from the scientific literature on aphasia, neurologically based speech changes in children are quite different from those in adults. So this is likely to be the case in FAS.
The body of scientific literature surrounding FAS is limited, so unfortunately, this rare neurological syndrome is sometimes unrecognized by medical professionals. This present lack of information and awareness makes it impossible to accurately determine the incidence of FAS. To date, the number of well-documented published cases of FAS within the United States is, to the best of our knowledge, less than 50. However, dozens of new cases have been identified within the past couple of years. On one hand, Coelho and Robb’s (2001) review of the literature found a higher incidence of FAS among females (approximately 62% for females versus 38% for males); on the other hand, Coleman and Gurd (2006) have published survey data of cases of FAS in the U.K. and estimated it has an almost equal incidence between genders (1: 1.17). Our own anecdotal reports have come almost exclusively from females. It is tempting to speculate that this gender gap relates directly to gender-related brain differences. It may provide some of the first scientific evidence that “men are not as likely as women to recover from strokes that affect the language areas of the brain” (Kent, 1997; p. 458). But this difference in incidence could also simply be because females are typically more willing to seek out and share life experiences than males. Only time and more scientific scrutiny to this specific aspect of FAS will tell. In many cases, FAS dissipates and normal speech patterns return. The time it may take for normal speech patterns to recover varies greatly across patients. In some cases, the foreign accent recovers gradually over a few months, while in others the foreign accent persists for many years with little or no sign of recovery. In our experience, cases which result from traumatic brain injury seem more likely to recover than those resulting from stroke. Presently, there are no known treatment programs specifically designed for individuals with FAS. However, some patients have benefited from therapy techniques (carried out by a certified SLP) focusing on increasing control over speech rhythm, timing and stress patterns (Garst & Katz, 2006). There may also be concomitant language or cognitive deficits associated with the neurological deficit which can be treated by professionals. Accent modification techniques may benefit some FAS speakers. These techniques are designed to increase sound awareness in speech production through regular therapy with an SLP. Accurate production of problematic vowels and consonants are typically the focus of therapy. However, depending on the type and severity of neurological damage, not all FAS speakers are likely to benefit from this type of therapy. In some cases, the patient may simply not be able to execute the precise motor movements of the lips, tongue and/or jaw required to accurately produce the target sounds. The following Web sites have information pertaining to FAS:
August 15, 2006 ASHA Leader online: www.asha.org/about/publications/leader-online/archives/2006/060815/f060815c.htm Kansas City Star: www.showmenews.com/2005/Dec/20051218News016.asp ABC News: http://abcnews.go.com/Primetime/Health/story?id=1806573&page=1 BBC News: http://news.bbc.co.uk/2/hi/uk_news/england/tyne/5144300.stm University of Central Florida Web site for the Department of Communication Sciences and Disorders: www.cohpa.ucf.edu/news/story_comdisclinic.cfm Dr. William Katz at the University of Texas at Dallas has set up a Web site for networking at:
www.utdallas.edu/~wkatz/FAS2/index_files/Page700.htm
There is also a Web site with postings from persons experiencng foreign accent symptoms at the following site, however, this page is not monitored for medical or scientific content:
http://cognews.com/1070262952/1140045433
References
Blumstein, S., Alexander, M., Ryalls, J., Katz, W., & Dworetzky, B. (1987). On the nature of foreign accent syndrome: A case study. Brain and Language, 31, 215-244. Coelho, C., & Robb, M. (2001). Acoustic analysis of Foreign Accent Syndrome: An examination of three explanatory models. Journal of Medical Speech-Language Pathology, 9(4), 227-242.
Croot, K. 2007. personal communication. Sydney, Australia. Fridriksson, J., Ryalls, J;, Rorden, C., Morgan, P. George, M. & Baylis, G. (2005) Brain damage and cortical compensation in foreign accent syndrome. Neurocase, 11, 319-324. Garst, D. & Katz, W. (2006 August 15). Foreign Accent Syndrome. The ASHA Leader, 11(10), 10. Kent, R. (1997). The Speech Sciences. San Diego, CA: Singular Publishing Group, Inc. Whitaker, H. (1982). Levels of impairment in disorders of speech. In R. N. Malatesha & L.C. Hartlage (Eds.), Neuropsychology and Cognition, 1, 168-207. The Hague: Nijhoff (NATO Advanced Study Institutes, Series D. No. 9).
Encounters with FAS
Click here to read Ryalls’ blog “Speaking in Tongues: Encounters with FAS.”
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