Foreign accent syndrome due to conversion disorder: Phonetic analyses and clinical course
Introduction
The foreign accent syndrome (FAS) is an acquired speech disorder in which a native language user suddenly starts using prosodic and articulatory patterns that cause listeners to perceive a foreign-sounding accent. To date, approximately 50 cases of FAS have been published in scientific journals, with a dramatic increase in the proportion of cases published in recent years (9% prior to 1980; 11% 1980–1989; 25% 1991–2000; 55% 2001–2008). A review of these cases shows that the etiology and presenting symptoms of FAS are far from uniform. Despite good agreement among listeners that the accent sounds “foreign,” there is typically poor agreement as to the language associated with the accent (e.g., Blumstein et al., 1987, Christoph et al., 2004, Gurd et al., 1988, Ingram et al., 1992). Detailed phonetic analyses of speech patterns have revealed allophonic variations that are atypical of the speakers' native language, particularly in prosody and vowel quality, but the unavailability of similar measures from the individuals' normal speech limits conclusions regarding the precise nature of the changes. In selected cases, preexisting audio recordings were available (e.g., Dankovičová et al., 2001, Gurd et al., 2001), but the content could not be customized to the analysis needs. In other cases, a normal control speaker or published group data were used as a reference for unaccented speech (Blumstein et al., 1987, Coelho and Robb, 2001, Laures-Gore et al., 2006, Miller et al., 2006, Varley et al., 2006), an approach that does not account for individual dialectal or idiosyncratic articulatory and prosodic variations.
Recently, we (Albert, Haley, & Helm-Estabrooks, in preparation) reviewed 30 published cases of FAS for which neuroanatomical information on lesion localization was available. We found the most likely clinicoanatomical correlate to be a small lesion deep in left frontal white matter pathways, anterior and superior to the head of the caudate nucleus. In the majority of these cases, the etiology was stroke or traumatic brain injury and the foreign accent emerged as a transient stage of recovery following initial stages of muteness, nonfluent aphasia, apraxia of speech (AOS), and/or dysarthria. It is difficult to derive further clinical relationships from the FAS literature because information about the course, medical history, coexisting signs or symptoms, and intervention approaches has been incomplete.
A few published reports indicate that FAS can occur without organic etiology. Some of these cases differ markedly with regard to onset from those with confirmed brain lesions. For example, a foreign accent emerged in two individuals during exacerbation of a psychosis and in the context of delusions, hallucinations, and disordered thought processes (Reeves et al., 2007, Reeves and Norton, 2001). In other cases with no evidence of neuropathology, psychogenic etiology of the FAS was more difficult to establish but seemed likely (Gurd et al., 2001, Poulin et al., 2007, Van Borsel et al., 2005). The speech characteristics in these cases were similar to those for individuals with documented brain lesions in that they included changes in prosody, vowel quality and duration, and allophonic consonant variations. Because very few detailed reports of FAS with possible psychogenic etiology have been published, and because the phonetic analysis has been limited in scope, it is critical to explore the phonetic speech characteristics in such cases in more detail.
In this report, we describe a case of FAS in which the etiology and evolution of the foreign accent were well documented and where detailed phonetic analyses were derived from identical speech samples with and without the accent. There was strong indication that the etiology was a conversion disorder. Six months after the onset of her symptoms, the patient made a complete recovery, allowing detailed phonetic comparison of identical speech samples produced with and without the foreign accent.
Section snippets
Presenting clinical history
DW, a 36-year-old woman, experienced sudden onset of symptoms one morning while showering. She described feeling a vibrating sensation in her head, ringing in her left ear, and an electric shock feeling in the left side of her body. She got out of the shower, looked in the mirror and noticed that the right side of her face was “scrunched up” while the left side was drooping. She tried to speak and thought her speech was slurred and difficult to understand. She was taken to a physician's office,
Differential speech diagnosis
The differentiation of FAS from more common neurogenic disorders that affect speech articulation and prosody is important for both clinical and theoretical reasons. In the majority of FAS cases, the accented speech evolved from, or coexisted with, nonfluent aphasia, apraxia of speech (AOS) and/or dysarthria. The close relationship with these neurogenic communication disorders has prompted some authors to question the validity of the diagnosis as a separate entity. For example, noting the
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2021, Journal of NeurolinguisticsCitation Excerpt :These are disorders where the symptom profile is inconsistent with an extant organic lesion(s) and/or where after careful clinical neurological, radiological, and/or physiological examination no obvious signs of neurological damage are apparent. Some functional cases are associated with frank psychiatric diagnoses such as psychoses, schizophrenia, bipolar disorder or mania (Haley, Roth, Helm-Estabrooks, & Thiessen, 2010; Jones, Story, Collins, DeJoy, & Edwards, 2011; Lewis, Ball, & Kitten, 2012; Reeves & Norton, 2001; Ryalls & Miller, 2014). Typically, speech returns to the person's habitual patterns once the psychosis passes.
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2016, Handbook of Clinical NeurologyCitation Excerpt :Of importance in the context of this chapter are the facts that FAS can emerge in individuals without identified organic etiology and that it may be functional, including in some individuals with confirmed neurologic disease (Gurd et al., 2001). Perusal of cases reported as lesion-based FAS suggests that the problem might in fact have been functional, and a number of published cases of FAS show strong evidence that the accent was functional (e.g., conversion disorder, psychosis) (e.g., Van Borsel et al., 2005; Verhoven et al., 2005; Reeves et al., 2007; Haley et al., 2010). On the basis of the accent alone, functional versus neurogenic FAS may not be reliably distinguished.
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2013, Journal of NeurolinguisticsCitation Excerpt :In rare instances, a posterior quadrant lesion has been the only abnormality apparent on imaging (Kwon & Kim, 2006; Roth, Fink, Cherney, & Hall, 1997). FAS has also been used to describe the clinical presentation of cases thought to be of psychiatric origin (Haley et al., 2010; Reeves, Burke, & Parker, 2007; Reeves & Norton, 2001; Tsuruga, Kobayashi, Hirai, & Kato, 2008; Van Borsel, Janssens, & Santens, 2005; Verhoeven, Marien, Engelborghs, D'Haenen, & De Deyn, 2005). These include cases of FAS emerging in the context of psychotic episodes (Reeves et al., 2007; Reeves & Norton, 2001); a case of psychogenic origin against a background of familial problems and suicidal depression (Van Borsel et al., 2005); and at least three cases described as conversion disorder manifesting as FAS (Haley et al., 2010; Tsuruga et al., 2008; Verhoeven et al., 2005).
Accent attribution in speakers with Foreign accent syndrome
2013, Journal of Communication Disorders
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Present address: Department of Speech Pathology and Audiology, UNC Hospitals, Chapel Hill, NC, USA.