Foreign Accent Syndrome

What is foreign accent syndrome?

Foreign accent syndrome (FAS) is a condition where the way you talk shifts and changes in a way that’s sudden and very noticeable. As the name suggests, it sounds to others like you’ve started talking with a foreign accent. FAS may indicate something is disrupting your brain function.

Though a person with FAS may sound like they’re speaking with a different accent, it’s usually a change in how a person makes certain sounds. Language experts and people who naturally have that accent (or a similar one) can typically pick out that it doesn’t fully match the accent it sounds most like.

Types of foreign accent syndrome

There are two main types of foreign accent syndrome.

• Structural: FAS can happen when there’s damage to areas of your brain that control muscles you use to speak.
• Functional: This is FAS that develops without a cause that healthcare providers can find. It may occur after seizures or with migraines, or it may be linked to mental health conditions that involve disorganized activity or hyperactivity in certain brain areas. Healthcare providers sometimes call this “psychogenic” FAS, meaning the cause isn’t structural.

There are also two other possible subtypes:

• Mixed. This means that you have functional FAS and also have a structural abnormality that doesn’t seem to be associated with the FAS.
• Developmental. This is FAS that can happen in people who are neurodivergent. This type of FAS may happen because of brain development and activity differences.

Sound changes vs. accent changes

Difficulty controlling different parts of your mouth can significantly change what you sound like. Those changes are more likely to stand out when listeners aren’t familiar with (or expecting) the way you make or use certain sounds.

For example, most regional accents in the United States involve using your tongue to say the “r” at the end of the word “car.” Without using your tongue, it rhymes with “ah,” which sounds more like an accent from the New England region of the U.S., Australia, New Zealand or certain parts of England in the United Kingdom.

However, FAS involves sound changes that aren’t consistent with an accent. For example, accents that replace the “r” in “car” with an “ah” sound still say the “r” in words like “carriage.” Someone with FAS (especially the structural type) will likely still not make that “r” sound. That means their speech won’t exactly match with the accent it’s similar to.

How common is this condition?

FAS is extremely rare. Pierre Marie, a French neurologist, first described the condition in 1907. There are about 100 confirmed cases on record since then.

What are the symptoms?

The symptoms of FAS relate to how you sound when you talk.

Main effects and symptoms

FAS mainly affects the rhythm of how you speak. Those disruptions can involve the following:

• Talking speed.
• Pitch and tone.
• Articulation (how precisely you form sounds).
• Stressing of syllables (which syllables you emphasize vs. which you don’t).
• Length of sounds.
• Volume (loudness of your voice).
• Inflections (like the way a statement becomes a question if your voice gets higher at the end).

Symptoms of either type of FAS can include:

• Talking more slowly or with varying speeds.
• More or longer pauses mid-word or mid-sentence.
• Drawing out certain sounds longer than necessary.
• Dropping or substituting sounds (like using an F sound in place of a TH sound to say “fumb” instead of “thumb,” or dropping the H in so “house” sounds like “ouse”).
• Slurring or having trouble clearly pronouncing certain sounds (similar to dysarthria).
• Switching sounds or making them in the wrong order (similar to what happens with childhood apraxia of speech).

Structural FAS

Structural FAS means that connections to brain areas you use for speaking or areas near your brain’s speech centers don’t function normally. Some other symptoms can include:

• Trouble choosing words (this happens in a different brain area than the one that handles muscle control for speaking).
• One-sided muscle weakness or paralysis (hemiplegia).
• Tremors or uncontrolled muscle movements.

Functional foreign accent syndrome

Functional FAS isn’t associated with brain abnormalities, and may happen alongside symptoms of mental health conditions like:

• Psychosis, such as hallucinations or delusions.
• Losing the ability to tell what’s appropriate to say or do.
• Mania- or depression-like mood and energy changes.

What causes the condition?

The causes of FAS depend on the specific type.

Structural FAS

Structural FAS typically happens because of damage that affects your frontal lobe (usually on the left side). Some of the most common causes of this damage include:

• Strokes.
• Traumatic brain injuries (TBIs).
• Brain aneurysm.
• Brain cancer.
• Multiple sclerosis (MS).
• Frontotemporal dementia (especially progressive primary aphasia).

Functional FAS

Experts aren’t sure why functional FAS develops. One possibility is that it results from brain activity that isn’t organized normally or brain areas that are too active. An example of this is FAS that happens or worsens during migraines, which are associated with broad disruptions in brain activity.

Healthcare providers may also link FAS to functional neurological symptom disorder (also known as “conversion disorder”). This is a condition where disruptions in your brain cause you to experience real physical symptoms that don’t have a detectable structural cause.

Functional FAS can be associated with certain mental health conditions. Examples include schizophrenia, bipolar disorder or dissociative disorders. More research is necessary to determine why that happens and what link — if any — exists between FAS and these conditions. The rarity of FAS makes research difficult.

Mixed FAS

Experts also aren’t certain why mixed FAS happens. One possibility is that some people are more prone to developing FAS. If they have a mental health change, an injury or an event like a migraine or seizure, that may be enough to disrupt brain activity and cause them to develop FAS. Similarly, a person might have functional symptoms before structural changes become detectable.

Another possibility is that functional FAS develops after structural FAS. Living with FAS can present challenges, and some people may develop functional symptoms when trying to adapt to their condition. An example is someone who has structural FAS from a head injury, but who continues to have functional symptoms after their brain recovers.

Developmental FAS

People who are neurodivergent may develop FAS or symptoms that are similar. Experts suspect this might be due to differences in brain development or function. Developmental cases are extremely rare and may actually be functional FAS associated with conditions like autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD).

What are the risk factors for functional accent syndrome?

There are no known specific risk factors that make FAS more likely to develop, primarily because it’s so rare.

What are the complications of foreign accent syndrome?

FAS can have major impacts on a person’s mental health. Depression and anxiety are much more likely to happen. That can be due to any of the following:

• Skepticism from family, friends or loved ones who question whether the condition and the symptoms are genuine.
• Difficulty getting a diagnosis because this condition is so rare, which means healthcare providers may not consider it or may misdiagnose it as another condition.
• Fears about negative reactions from others, such as ridicule or bullying.
• Anxiety about being misunderstood when trying to communicate.
• Trouble keeping or getting a job because of the way you talk.
• Worsened symptoms of existing mental health conditions (both those that might cause or contribute to FAS and those that don’t).

How is foreign accent syndrome diagnosed?

A healthcare provider, typically a neurologist, speech-language pathologist (SLP) or both will diagnose FAS using a combination of methods.

Some of the most common tests and diagnostic methods include:

• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI) scan.
• Positron emission tomography (PET) scan.
• Electroencephalogram (EEG).
• Single photon emission computed tomography (SPECT) scans.
• Neurological exam.
• Cognitive testing.
• Neuropsychological testing.

Structural FAS is the easiest to diagnose because imaging and diagnostic tests can detect most causes.

How is foreign accent syndrome treated?

Treatment for structural FAS generally revolves around treating whatever caused it. Those treatments can vary widely, and what works for one condition may not work for another. Your healthcare provider can tell you more about possible treatments and which they recommend.

Functional and mixed types of FAS, especially with mental health conditions, may improve with treatment of the underlying or related condition. Conditions like schizophrenia or bipolar disorder may be treatable with medication, mental health therapy or a combination of the two.

All cases of FAS will likely benefit from speech therapy. It can help people understand the specific sound changes that make up their accent change and try to improve or correct them. It can also help people develop compensating strategies that make it easier for them to communicate and help them feel more comfortable around others.

Can foreign accent syndrome be prevented?

FAS happens unpredictably, and it’s extremely rare. Because of that, there aren’t any clear ways to prevent it or reduce your risk.

You can reduce your risk in general by avoiding some of the most common causes of structural FAS. These include:

• Wear safety equipment. Head injuries are one of the most common causes of FAS. Using safety equipment can help you avoid injuries that might cause FAS. Examples include helmets and seat belts (or other vehicle safety restraints).
• Manage health conditions. Conditions that can increase your risk of stroke are often manageable. Examples include migraines, Type 2 diabetes and high blood pressure (hypertension).
• Reach and maintain a weight that’s healthy for you. You can reduce your risk of having a stroke or limit the severity of one by taking care with what you eat and how active you are. These can’t completely prevent conditions that could cause FAS, but even small changes may help.

What can I expect if I have foreign accent syndrome?

FAS isn’t dangerous (though it can happen with some conditions that are). However, FAS can be disruptive or distressing. This is especially true if you have trouble getting a diagnosis.

The course of FAS depends on what causes it, the specific symptoms you have and more. Because it’s so variable, your healthcare provider is the best person to tell you more about what you can expect.

How long does foreign accent syndrome last?

The duration of foreign accent syndrome can vary widely. Structural causes of it can be temporary or permanent depending on whether the brain change is permanent and/or if your brain can recover from whatever’s causing it.

In some cases, it may be possible to reverse the effects or for you to recover quickly, possibly in a few days. In others, it might take longer, such as weeks or months. Some causes of FAS are permanent. Frontotemporal dementia and multiple sclerosis are examples of causes that are more likely to be permanent.

What’s the outlook for this condition?

The outlook for FAS can vary depending on multiple factors. It’s not a dangerous condition on its own. But there’s little available research for experts to determine the general outlook for this condition. Your healthcare provider is the best person to tell you about what to expect in your specific case.

How do I take care of myself if I have foreign accent syndrome?

If you have a confirmed case of FAS, your healthcare provider can give you specific guidance on what you can do. One of the most important things you can do is participate in speech therapy if it’s recommended. Depending on your specific situation, speech therapy can help you recover from FAS or learn to adapt to it.

When should I see my healthcare provider?

If you have a confirmed diagnosis of FAS, you should see your healthcare provider as they recommend. You should also see them if you notice changes in your symptoms.

When should I go to the ER?

If you have sudden speech changes, you should go to the nearest emergency room.

Is foreign accent syndrome a real thing?

Yes, foreign accent syndrome is a legitimate medical condition. It’s extremely rare, but it does happen.

What do I do if my healthcare provider doesn’t believe my symptoms are genuine?

It’s important to keep in mind that FAS is incredibly rare. Most healthcare providers go their whole careers without seeing a single case. It’s even possible for trained, experienced healthcare providers to misdiagnose FAS as something else. It can be scary if your healthcare provider can’t find evidence to support your symptoms or seems skeptical. If your provider is unable to find a cause for speech changes, you should see a specialized speech therapist or neurologist for a second opinion.

A note from Cleveland Clinic

Foreign accent syndrome is a rare, unusual condition. But it’s real. And it’s something experts are still trying to better understand. Some causes of FAS are detectable with imaging scans or diagnostic tests. Others may not be detectable with current technology and methods.

Detectable or not, FAS is a condition that can severely disrupt your life. Sometimes it’s temporary, but it might also be permanent. If you have this condition, talk to a healthcare provider. Talking to a provider about this condition might feel silly or scary. But the truth is that it’s a legitimate medical concern. With treatment, it might be possible to reverse or minimize its effects so you can speak with confidence to the people around you.