Alexandra Bey, MD, PhD, is a child psychiatrist in the Duke Autism Clinic and a researcher in the Duke Center for Autism and Brain Development. Dr. Bey’s research and clinical career is dedicated to improving the lives of those with neurodevelopmental disorders. Communications strategist Evan Watson sat down with Dr. Bey for a conversation about her career and research goals, and how her dual roles in research and patient care overlap.
Tell me how you got started in your career.
As an undergraduate at UNC Chapel Hill, I was just starting to explore my options in science. I didn’t know there was such a thing as a physician/scientist, doing both laboratory research and taking care of patients, and I felt torn about which path to pursue. But during a post-baccalaureate fellowship at the National Institutes of Health in 2007, I met people doing that and realized I could pursue both.
How long have you been with the Duke Center for Autism and Brain Development?
I came to Duke in 2008 to pursue an MD/PhD in neurobiology. In Dr. Yong-Hui Jiang’s neurogenetics lab, I used mice as a model for autism-related neurodevelopment. I also loved caring for patients with developmental, psychiatric, and medical conditions during my pediatrics, neurology, and psychiatry rotations in medical school.
I joined the Duke Center for Autism and Brain Development in my last year of med school in 2017. Dr. Jiang introduced me to Dr. Geraldine Dawson. I had seen a lot of mouse models of autism and neurodevelopmental disorders—genetic mutations in mice that mimic human conditions—but I wanted to learn more about how to take care of people with genetic syndromes related to neurodevelopment. I chose Duke Psychiatry for my medical residency specifically so I could get training within the Duke Center for Autism and Brain Development.
How did the lab incorporate mice into autism research?
During my PhD, we would take discoveries from the genetics clinic and try to replicate the mutation in mice. I analyzed the impacts of autism-related genetic mutations on the brains and behavior of mice, and we tried to identify new treatment targets using those discoveries.
You could say I was a mouse psychiatrist, but I was also getting more clinical training to become a psychiatrist for children and adults with neurodevelopmental conditions.
In residency, I learned techniques in Kafui Dzirasa’s neurobiology lab to record brain activity from these mice to understand how genetic differences lead to brain differences that lead to behavioral differences. At this point, you could say I was a mouse psychiatrist, but I was also getting more clinical training to become a psychiatrist for children and adults with neurodevelopmental conditions.
Both of my former mentors, Dr. Jiang and Dr. Dzirasa, are physician-scientists. They’re researchers who care about taking care of patients and how the research impacts care years down the road. That is my goal, too. This led me to pursue further training in clinical research with Dr. Dawson serving as my primary mentor now.
There is a lot of overlap in how we recorded brain activity and behavior in mice and what I am learning to do now with children. It’s been cool to use similar techniques that I learned with mice to help serve our Duke Autism Center of Excellence participants. Even if it’s not a treatment study, diagnostics and description help people understand their kids better.
What projects are you currently working on?
I’m in the clinic one day a week as a psychiatrist. A lot of my time right now is with the COMET study, part of the Duke Autism Center of Excellence (ACE). An award from the National Institute of Mental Health and a grant from the Klingenstein Third Generation Foundation help support my work on the project.
Also with the ACE, we continue to do secondary analysis on data from the HERO study and our prior ACE study, and writing about our conclusions from that. I still collaborate with Kaf Dzirasa on papers in publication related to the work I was involved in with his lab a few years ago. That process takes a long time—from conducting a study, to analyzing data, to publishing a paper that might turn into a new treatment.
All these projects let me see the whole lifecycle of research on a new idea through to patient care. There is a role for mouse science to help us discover new treatment possibilities and it’s important to do clinical research to apply these discoveries in a human context.
You did your MD, PhD, psychiatry residency, and child and adolescent psychiatry fellowship at Duke. What has kept you at Duke?
The administration and leadership have been so supportive as I’ve gotten clearer on what I want to do, giving me opportunities to switch gears and do both clinical care and research. And my family is in North Carolina, so there are personal reasons I want to stay here in the Triangle.
The Duke Autism Center of Excellence and other funding opportunities have helped my ability to stay here. And I really appreciate being able to build on existing work, to continue collaborating on interdisciplinary projects with mentors from other departments at Duke.
How do your roles as a physician and a research scientist inform each other?
In the clinic, I see kids who are the same age, with the same diagnosis, who respond to treatments differently. They’ll have different outcomes. It makes me curious as a scientist about why that is, or whether we can better predict this. The COMET research is looking at what underlying differences at brain level that could explain that. Finding distinct biotypes [specific categories of characteristics that we can measure] could help us tailor different supports or therapies. It would save families a lot of questions, heartache, and struggle if we could tell them exactly what will work best for their child.
In research, I’m thinking as a physician about the questions we ask: How will this serve families in the future? Are we building a tool that I can picture myself using in clinic as a decision support tool?
What kind of patients do you see?
About half of the patients I see have specific genetic syndromes and neurodevelopmental disorders associated with autism, ADHD, epilepsy, and developmental disabilities. Some are very rare mutations to a particular gene, and some are more well-known, like Down Syndrome.
The other half are autistic kids without any particular syndrome. They may have the same diagnosis—autism—but no two kids are the same, and they need different kinds of support.
What else do you want people to know about your work?
Both environments are really team oriented: the nurses, physicians, social workers, clinical psychologists, researchers, everyone has the same mission.
I’ve benefitted from interdisciplinary backgrounds, training experience, and expertise across the research and clinical spaces, and that influences how I think about both research and clinical care.