Dr. Elysa Marco is a behavioral child neurologist who specializes in autism spectrum disorders. In addition to treating her young patients, Marco also serves as director of research for the UCSF Autism and Neurology Center. She completed her medical training at the UCSF School of Medicine, where she is now a clinical instructor of child neurology.
What drew you to this field?
I've always been interested in the intersection of brain and behavior, so neurology was a clear choice when I entered medical school. And when I started doing rotations, it became clear that I was a pediatric neurologist — these were the people I liked to interact with and the disorders I liked to work on, in part because it's very hopeful. If you make an intervention early enough, you can affect the child's development from that point forward.
What's your research about?
It's clear to me from my clinical role as well as my research that many kids with autism have problems with basic sound and touch processing — the way they hear and feel, and sometimes see, the world around them. My research focus is to really understand how basic sensory information comes in and is processed, both in typical kids and in kids with neurodevelopmental disorders and acquired injury. To accomplish that I do functional imaging using a couple of cutting-edge techniques: magnetoencelophogram and functional MRI.
We also have a new stream of research looking at a computerized assessment and training tool for kids. It looks at how they do on basic sensory processing tasks and tries to help them in weak areas.
Like a video game?
Exactly! All the kids are playing them anyway, so why not use that time to affect their development in a positive way?
You might as well go with what they're interested in…
Absolutely. We all learn best and fastest when we're interested.
Any interesting new findings in autism research?
There's always exciting research coming out because there are so many smart people looking at autism, but I do have two top picks for 2011. A UC Davis study found that even expert diagnosticians are unable to identify kids who will later be diagnosed with autism when they're six months old. There had been the thought that, in kids who are diagnosed with autism, it was always there. This shows that at six or nine months, kids who become autistic are indistinguishable from those who don't.
We always knew that there's a percentage of kids who regress — about 30 percent — but it looks like regression is universal. What's most exciting for me is, if at six months you can't distinguish the kids who will later be diagnosed with autism, we may be able to prevent the regression if we intervene early enough.
The second study, looking at genetic heritability in autism, came out of a collaboration between UCSF, Stanford, Kaiser and UC Davis. It's long been quoted that among monozygotic [identical] twins who share 100 percent of their DNA, the rates of both twins being diagnosed is much higher than in dizygotic [fraternal] twins, which argues for a strong genetic component. This study looked at a large sample of twins — all the previous studies were tiny — and it turns out the genetic factor is still very strong, but less strong than we thought, and the environmental component is stronger than we thought.
There's a proposal to change the criteria for autism spectrum diagnosis. Any opinion on the proposed changes?
I think it moves to more of a lumping rather than a splitting concept, which makes sense as a starting point. Clearly for both patient care and research purposes, we need to be much more precise in thinking about the variability we see within the autism spectrum diagnosis. For example, a child with no language and a child with abundant language can both be called autistic, but their causes and their educational interventions need to be very, very different.
I like the additional focus on unusual sensory behaviors, which are now explicitly included within a subdomain of stereotyped motor and verbal behaviors. My research is heavily focused on basic sensory processing, so I think this is a move in the right direction, both for understanding causes and for defining appropriate treatment.
What advice would you give a parent whose child has just been diagnosed with autism or a cognitive deficit disorder?
If there's a concern for autism or a related disability, the child should get at least one thorough evaluation to look for the underlying cause. Seeing either a neurologist, geneticist or developmental pediatrician is a good idea.
The parents also need to make sure they're getting good family support, because the health and well-being of parents directly contribute to their child's development. I also recommend getting to know the special education team at the child's school very well — having a really skilled occupational and speech therapist is important. Choosing the provider is always personal. Make sure it's somebody who makes you feel heard. You should know you'll always get something out of every visit, even if it's hard.
If you weren't a doctor, what would you do for a living?
My hobby is flying trapeze. If I hadn't become a doctor my dream would be to become a flying trapeze artist, but I don't know that I would have had the talent to make it to the big-top.
I was going to ask next what your patients would be surprised to learn about you, but I think flying trapeze answers that question too.
They'd probably be surprised. Although I often wear striped socks — that may be a tip-off.
You've stuck with UCSF throughout your training and career. What do you like about working here?
I came to UCSF even before starting medical school, to work in a research lab. It's the people. I have the best mentors in the world and the nicest, smartest, most creative colleagues — not just in child neurology, but in neurosurgery, pediatric neuroradiology and psychiatry, as well as my research colleagues.
Another thing about UCSF is, there's nothing you can't do. If you have an idea, you can find the resources, support and expertise at UCSF as long as you're looking. Especially in child neurology — it's an incredible division.
Any personal heroes?
Donna Ferriero who was the head of child neurology and now is chair of pediatrics. She's smart. She's caring. She always makes time for her trainees and she gives her patients the best care possible.
Interviewed by Sierra Tzoore.
Photo by Tom Seawell.