CBD-enriched cannabis for autism spectrum disorder: an experience of a single center in Turkey and reviews of the literature
Introduction: Autism spectrum disorder is a neurodevelopmental disorder characterized by deficits in communication, social interaction, restricted interest, and repetitive behaviors. Although more cases are being diagnosed, no drugs are approved to treat the core symptoms or cognitive and behavioral problems associated with autism. Therefore, there is an urgent need to develop an effective and safe treatment.
Objective: In this study, we aim to share our 2-year experience with CBD-enriched cannabis treatment in autism and review the latest studies.
Materials and methods: The study included 33 (27 males, six females) children diagnosed with autism spectrum disorder who were followed up between January 2018 and August 2020. The mean age was 7.7 ± 5.5 years. The average daily dosage of cannabidiol (CBD) was 0.7 mg/kg/day (0.3-2 mg/kg/day). The median duration of treatment was 6.5 months (3-28 months). The preparations used in this study contained full-spectrum CBD and trace elements tetrahydrocannabinol (THC) of less than 3%.
Results: The outcomes were evaluated before and after treatment based on clinical interviews. At each follow-up visit, parents were asked to evaluate the effectiveness of the CBD-enriched cannabis treatment. According to the parents’ reports, no change in daily life activity was reported in 6 (19.35%) patients. The main improvements of the treatment were as follows: a decrease in behavioral problems was reported in 10 patients (32.2%), an increase in expressive language was reported in 7 patients (22.5%), improved cognition was reported in 4 patients (12,9%), an increase in social interaction was reported in 3 patients (9.6%), and a decrease in stereotypes was reported in 1 patient (3.2%). The parents reported improvement in cognition among patients who adhered to CBD-enriched cannabis treatment for over two years. The antipsychotic drug could be stopped only in one patient who showed mild ASD symptoms. No change could be made in other drug use and doses. Additionally, this study includes an extensive review of the literature regarding CBD treatment in autism spectrum disorder. According to recent studies, the average dose of CBD was 3.8±2.6 mg/kg/day. The ratio of CBD to THC in the used preparations was 20:1. The most significant improvements were seen in the behavioral problems reported in 20-70% of the patients.
Conclusion: Using lower doses of CBD and trace THC seems to be promising in managing behavioral problems associated with autism. In addition, this treatment could be effective in managing the core symptoms and cognitive functions. No significant side effects were seen at the low doses of CBD-enriched cannabis when compared to other studies.
Keywords: Autism spectrum disorder; Cannabidiol; Cannabis.
CBD Oil as a Treatment for Autism
Lisa Jo Rudy, MDiv, is a writer, advocate, author, and consultant specializing in the field of autism.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Arno Kroner, DAOM, LAc, is a board-certified acupuncturist, herbalist, and integrative medicine doctor practicing in Santa Monica, California.
Cannabidiol , sometimes called CBD, is a chemical compound found in the cannabis plant. Since it does not include THC, the psychoactive component of cannabis, CBD does not induce a “high.” It can, however, help to reduce anxiety and lower stress levels—symptoms that are common among people with autism.
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.
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.
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.”
In numerous studies, CBD was able to reduce the number of seizures, and in some cases, it was able to stop them altogether. Recently, the FDA approved the first-ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD. CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.”
CBD is not helpful for everyone who uses it, and, in rare cases, it can cause side effects such as sleepiness or nausea.
How CBD May Help People With Autism
Neither CBD nor any other drug can remove or cure core symptoms of autism, which include social communication challenges, sensory dysfunction, and restricted, repetitive behaviors. CBD can, however, help to alleviate disorders often associated with autism such as epilepsy, anxiety, sleeplessness, and stress.
By relieving the associated disorders, CBD may help reduce some of the most problematic aspects of autism.
For example, it may cause better sleep and lower anxiety (which can reduce aggressive behaviors), fewer seizures (which can lessen stress and make it easier to interact socially), and lower anxiety to make it easier to learn and use social communication skills.
It’s also important to note that sleeplessness and aggression are particularly difficult symptoms for parents, who can quickly find themselves exhausted and overwhelmed. Aggression, in particular, is one of the most challenging behaviors common to autism—oftentimes, this is a reason a parent may place their child with autism in an institutional setting.
A few full-scale studies have explored the impact of CBD on children with autism—none, however, have explored its impact on adults on the spectrum. One of the largest such studies took place in Israel. The report includes the following finding:
“In 2014, The Ministry of Health began providing licenses for the treatment of children with epilepsy. After seeing the results of cannabis treatment on symptoms like anxiety, aggression, panic, tantrums and self-injurious behavior, in children with epilepsy, parents of severely autistic children turned to medical cannabis for relief.”
The results of the study were encouraging. Most of the children involved saw improvement in anxiety, anger, and hyperactivity.
In addition (and perhaps as a result), they also saw significant improvements in social communication, sleep, and self-injury (a small percentage, however, worsened with treatment). A tremendous bonus is the fact that there were few side effects, and those that did appear (sleepiness and change in appetite) were mild.
Additional studies have provided similar results: CBD has proved to be helpful in a majority of cases in lessening emotional and behavioral issues and can even help to improve social communication skills. These preliminary findings, along with the low incidence of significant side effects, are very encouraging. Studies are ongoing in clinics and research centers around the world.
Before Trying CBD
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:
- Check with your child’s (or your) doctor to be sure that no allergies or sensitivities exist that could cause a reaction to CBD.
- Check to be sure that CBD is legal in your state, province, or country.
- Research sources of CBD to be sure the brand you’re using is well-regarded and properly licensed.
- Take careful notes to be sure you have baseline information about your child’s (or your own) behaviors and symptoms so that you can make a useful comparison before and after using CBD.
CBD comes in many forms and at many dosage levels. Oils taste somewhat bitter, which is why many people prefer chewable candy-like options; of course, it’s important to keep candy-like drugs and supplements out of the reach of children.
In general, it’s best to start with a lower dosage. In fact, studies of CBD for other disorders such as migraine suggest that a lower dose may be more effective.
Lower doses are also more easily tolerated than a higher dose.
When you start using any new supplement, drug, or treatment, it’s important to be sure your child’s doctor is aware of the new treatment and has no concerns about it relative to your child’s health as well as let everyone working with your child know that you’ve started something new and ask them to look for and report any changes in behaviors or skills.
Take careful notes of any changes you see yourself so you can easily review your records to determine how helpful the new treatment really is and keep an eye open for any troubling side effects. Be sure to communicate any side effects to a doctor or healthcare professional immediately.
A Word From Verywell
Children with autism grow and learn every day, simply because they are maturing. As a result, there is no simple way to determine whether a change in behavior or an increase in skills is due to a particular treatment or to ordinary maturation. This reality makes it very easy to see a change in behaviors and inaccurately attribute them to the newest treatment you’ve tried. By far, the best way to know whether a particular treatment is truly effective is to be rigorous about evaluating your child before and after its use.
To do this, you’ll need to create or find and use a numerical scale (1 to 5 for instance) to measure your child’s behavior. For example, is today’s angry outburst at a level 1 or a level 5? By carefully evaluating the impact of a new therapy, you can eliminate the likelihood that you’ll make decisions based on wishful thinking rather than on solid evidence.