Lower doses are also more easily tolerated than a higher dose.
Claims for CBD range from the realistic to the absurd. Some websites and companies claim, for example, that CBD can cure cancer (it can’t). On the other hand, CBD does seem to alleviate some untractable symptoms of disorders such as epilepsy, sleeplessness, and anxiety—all common issues for people with autism. According to Harvard Health Publishing, “the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications.”
CBD can be derived from hemp or cannabis (the marijuana plant) and is now legal in many states in the United States and in many countries around the world. It can be purchased without a prescription as an oil, tincture, pill, or chewable pill online and is also an ingredient in edibles ranging from coffee to pastries. It comes in many dosages and at many price points.
Currently, there is some evidence that CBD can help to alleviate specific symptoms and improve behavior in children and adults on the autism spectrum, but research into the safety and efficacy of CBD is in its earliest stages.
The results of the study were encouraging. Most of the children involved saw improvement in anxiety, anger, and hyperactivity.
CBD is not helpful for everyone who uses it, and, in rare cases, it can cause side effects such as sleepiness or nausea.
Given all of the positive findings for CBD and the low risk associated with it, it may make sense to try using it with your child with autism (or trying it yourself if you are an adult with autism). Before buying a bottle of CBD oil, however, it’s important to follow these steps:
Although the aforementioned studies illustrate the potential of cannabis to treat core symptoms of ASD, these studies are constrained in their scope of evidence given their small sample sizes, lack of control groups, and other reported limitations. As such, results from the two clinical trials pending publication of results and completion, and additional large scale clinical trials specific to this population will help build evidence for the safety and efficacy of medical cannabinoids for ASD patients. Until this time, evidence for cannabis use in this population can be merely inferred from studies conducted for pathological conditions shared by other patient populations . However, as noted by Pretzsch et al. , the inference and transferability of the effects of cannabis treatments from populations without neurodegenerative conditions on the ASD population are speculative.
Today, however, cannabis, which is also commonly referred to as marijuana, remains illegal under federal law in the United States and is categorized as a schedule 1 drug under the Controlled Substances Act. At the state level, cannabis for medical purposes has been decriminalized in over 34 states , although physicians remain hesitant in recommending its use given the sparse state of evidence regarding its efficacy to treat specific conditions .
In another study also conducted in Israel , 53 children with ASD were administered oral cannabinoids under supervision. A 1:20 ratio of CBD and THC was used for a mean duration of 66 days, at a concentration of 30%, with a recommended daily dose of 16 mg/kg for CBD and 0.8 mg/kg of THC (maximal daily dose of 600 mg and 40 mg respectively). The study examined changes in the child’s comorbid symptoms using prospective bi-weekly interviews with parents. Effects of cannabidiol in respect to hyperactivity, sleep problems, self-injury, and anxiety were reported as an improvement, no change, or worsening. Of interest, changes within the cohort for these symptoms was compared to peer-reviewed data for treatment using conventional methods. As such, hyperactivity was considered improved at 80%, self-injury at 82%, sleep problems at 60% and improvement in anxiety symptoms at 64%. Of the children who displayed hyperactivity symptoms, over 68% reported improvement, over 28% had no change, while almost 3% reported worsening of hyperactivity. Improvements in self-injurious behavior were seen in almost 68% of children, 23.5% had no change while almost 9% reported worsening of self-injury. Over 71% reported improvements in sleep, 23.8% had no change, while 4.7% reported worsening effects. Anxiety was improved in over 47% of children, almost 30% had no change, while 23.5% had worse anxiety symptoms. Consequently, the study reported a 74.5% overall improvement in symptoms of ASD comorbidities, although mild adverse effects of somnolence and decreased appetite were reported in 12 and 6 children respectively. The authors reported no statistically significant difference in hyperactivity, sleep or anxiety of cannabidiol oil compared to conventional treatments of these symptoms. Study limitations, however, include lack of an objective assessment tool and a control group .
Evidence from shared conditions
Thus far, only five research studies to the best of our knowledge exist which have examined the direct effects of medical cannabis in individuals with ASD. The most recently published study conducted in Israel, examined the safety and efficacy of medical cannabis use amongst 188 patients with ASD. Most patients were treated using cannabis oil (1.5% THC and 30% CBD), and functional activities of daily living, mood, and quality of life were assessed using structured. Only 93 parents of 155 active participants participated in the six-month follow-up, but a third of participants reported a significant improvement on the three endpoints. Side effects were experienced by approximately 25% of patients, with the most common side effects reported as restlessness followed by sleepiness and psychoactive effects. This study is limited by the follow-up attrituion at the one and six-month follow-up, which was not explained in the publication .
Despite the fact that promising outcomes were experienced for participants with ASD, adverse events were reported by 57 parents. These side effects most commonly included hypervigilance, which led to worsening sleep concerns (14%), irritability (9%), loss of appetite (9%), and restlessness (9%). Other frequently cited adverse events included gastrointestinal symptoms, mood changes, fatigue and unexplained laugh. One serious adverse event was reported, with one participant experiencing a transient psychotic event. The study suggests that strains of medical cannabis with a high THC concentration (6:1-CBD to THC ratio) might increase the likelihood of lead to a psychotic state requiring antipsychotictreatment. The uncontrolled retrospective nature of this study has been cited by the authors as a limitation of this study, in addition to the potential for placebo effects reported in controlled treatment studies in children with ASD, as reported by King et al. [60, 63].
Hence, a conflicting spiral exists. Without scientific evidence to establish efficacy, cannabis as a potential course of treatment is often not recommended by practitioners. In turn, until the status of cannabis is changed from a schedule 1 drug, research on the potential uses of marijuana and its components is greatly inhibited .
Although less common, psychosis has also been identified as a comorbidity for ASD . As CBD has been shown to have antipsychotic properties in both human and animal studies, an exploratory double-blind parallel-group study was conducted to examine the safety and efficacy of CBD in patients with schizophrenia. Randomized patients were to receive CBD (1000 mg/day) or placebo. If currently prescribed antipsychotic medications, the placebo or CBD was prescribed in addition to the current regiment. CBD may potentially be offered as a new line of treatment for these psychiatric conditions, as “CBD was well tolerated, and rates of adverse events were similar between the CBD and placebo groups” . However, given the adverse outcome of a serious psychotic event discussed earlier in a preliminary study with a patient with ASD , the effectiveness of CBD to address psychosis in ASD merits further evaluation.
For all participating children this was their first experience with cannabidiol and no other cannabinoids were used before this study. During the first meeting, parents were instructed by an experienced nurse practitioner how to administer the preparation. Thereafter, a biweekly follow-up telephone interview was conducted with the parents. During the telephone interview, parents were asked on the status of the various ASD comorbid symptoms (graded as improvement, no change, worsening), emerging adverse effects and medications that had been used. Adverse events were coded using the Medical Dictionary for Regulatory Activities (Food Drug Administration, 2004). The change in each comorbid symptom in the study cohort was compared to published data using conventional treatment. For this purpose we used the following values: Hyperactivity symptoms- Improvement was considered as 80% (Handen et al., 2000), for self-injury an improvement was considered as 82% (Richards et al., 2016), for sleep problems an improvement was considered as 60% (Devnani and Hegde, 2015), and improvement in anxiety symptoms was considered as 64% (Moore et al., 2004).
Reports on 38 children with hyperactivity symptoms were recorded. Of them, 68.4% had improvement of symptoms, 28.9% had no change and worsening of symptoms was reported in 2.6%. The improvement was not statistically different from that of the conventional treatment published in the literature (p = 0.125).
Categorical variables such as gender, related ASD comorbid symptoms, were described using frequency and percentage. Continuous variables such as age and daily CBD dose were evaluated for normal distribution using histograms and Q–Q plots. Normally distributed continuous variables were described as mean and standard deviation and skewed variables were expressed as median and interquartile range or range. Length of follow-up was described using a reverse censoring method. A comparison of improvement in symptoms between CBD treatment and conventional treatment was analyzed using binomial test. All statistical analyses were performed using SPSS (IBM Corp 2016. IBM SPSS Statistics for Windows, Version 24.0, Armonk, NY: IBM Corp.).
Conclusion: Parents’ reports suggest that cannabidiol may improve ASD comorbidity symptoms; however, the long-term effects should be evaluated in large scale studies.
Patients characteristics and baseline symptoms.