What You Should Know About CBD and Autism
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People are looking to CBD to manage autism symptoms, but does it work? Here's what experts say.
About 1 in 54 children has been diagnosed with autism spectrum disorder (ASD), a group of developmental conditions with a wide range of symptoms, including challenges communicating and interacting, repetitive behaviors, learning difficulties, focused interests, anxiety and behavioral problems like aggression.
Because ASD is a lifelong condition, many adults also have it.
There’s no specific treatment for autism, so doctors rely on strategies geared to specific patients and specific needs, such as training to improve social skills or speech therapy to address communication challenges.
Doctors may prescribe medication for certain symptoms, such as anxiety and depression. Increasingly, parents and patients are turning to cannabidiol, or CBD, for help with behavioral issues.
Anecdotal reports suggest CBD may have some benefit, but what do we really know about these products and their affect on autism?
CBD vs. THC
People often confuse CBD with delta-9-tetrahydrocannabinol (THC), but while they both come from the cannabis plant, they’re not the same thing.
THC is the ingredient that causes the “high” of marijuana. CBD does not cause a high but may have potential health benefits. Together, CBD and THC are the two major chemicals in the cannabis plant, although there are hundreds of other compounds as well.
CBD can also be extracted from hemp. Like marijuana, hemp is a cannabis plant, but it has lower THC levels. Thanks to the 2018 Farm Bill, farmers are now allowed to grow hemp as long as it contains no more than 0.3 percent THC. (Learn more about the differences between THC vs. CBD.)
How does CBD work?
CBD works in a couple ways. CBD affects messages between nerve cells in areas of the brain that play a role in anxiety, behavior, and executive function (think mental skills that include planning, regulating emotions, and paying attention).
It also interacts with the body’s endocannabinoid system. The endocannabinoid system (named after—you guessed it—cannabis) is made up of naturally occurring compounds called endocannabinoids, receptors on cells that react with them, and the enzymes that help make them and break them down.
The system can help regulate appetite, mood, pain perception, inflammation, stress response, and other functions.
“There are a handful of studies that show that people with autism have low levels of endocannabinoids in their body,” says Bonni Goldstein, MD, medical director and owner of Cannacenters, a medical practice in Los Angeles, and author of Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain.
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The science behind CBD and autism
So far the scientific evidence for CBD as an autism treatment is slim to none, says Gregory Barnes, MD, PhD, a neurologist with Norton Children’s and the University of Louisville in Louisville, Kentucky. Importantly, there haven’t been any randomized controlled trials, which are considered the gold standard in medicine to prove a treatment is effective.
There have, however, been less-rigorous, preliminary studies that have shown promising results. In 2019, the journal Scientific Reports published a study of 188 children with ASD who took CBD oil, under the tongue, three times a day.
After six months, 166 were still in treatment. Of those, 30 percent of parents reported a significant improvement and 53 percent said there were moderate improvements. (Keep in mind that there was no placebo group in the study, so it’s impossible to say how much of the improvement was due to the placebo effect.)
About 25 percent of children experienced at least one side effect, and the most common was restlessness.
A similar and much smaller study of 15 children was published in 2019 in Frontiers in Neuroscience. In that study, most children showed some level of improvement in at least one of eight ASD symptom categories after 6 to 9 months of treatment with CBD-containing capsules.
The first randomized controlled trial on CBD for problem behaviors in autism is going on right now at the University of California San Diego. “We hope the study to be completed in late 2021,” says principal investigator Doris A. Trauner, MD, professor in the department of neurosciences at UC San Diego School of Medicine.
CBD, autism, and epilepsy
About 30 percent of people with ASD also have seizures over their lifespan, according to the American Academy of Pediatrics. Though there isn’t strong evidence to support CBD’s possible benefits for many conditions, the science is more solid when it comes to the compound’s effect on epilepsy. One CBD drug, Epidiolex, has been approved by the Food and Drug Administration (FDA) for rare forms of childhood epilepsy.
Many people with autism and epilepsy also try this medication, even though it’s not specifically approved for other types of epilepsy. “When appropriate, I do try to get patients on Epidiolex,” says Dr. Barnes. “It may have helped a few kids. It’s a very good epilepsy drug.”(Learn more about using CBD for seizures.)
It’s not approved to treat behavioral challenges either, but the drug may have potential in that area, Dr. Barnes says. “A lot of the improvements I have seen have been in communication, whether it’s raising your hand up to say hello or a few more words,” he adds. “There may be something there but we’re certainly not there yet.”
Safety in children
CBD is generally considered safe in adults, says Martin A. Lee, cofounder and director of ProjectCBD, a California nonprofit that promotes CBD research, and author of Smoke Signals: A Social History of Marijuana—Medical, Recreational, and Scientific. Keep in mind: CBD may interact with other medications, so talk with your doctor before starting.
There’s less information on how safe it is in children, whose brains are still developing. “It’s still somewhat controversial,” says Dr. Goldstein.
In her ongoing study at UCSD, Dr. Trauner is finding “the safety profile appears to be similar to that documented in the studies of children with severe epilepsies.” (The possible side effects of Epidiolex include an increase in liver enzymes, sleepiness, and loss of appetite, among others.) But the study uses a highly controlled form of CBD.
When it comes to commercially available products, there’s no government regulation ensuring a product contains what it says, in the amount it lists.
“Even an over-the-counter product is still a drug, and they can cause liver inflammation,” says Dr. Barnes, who has seen this in at least one patient. Some products also contain THC, which is thought to increase the risk of psychotic episodes in some teens and young adults.
“I always tell my patients it’s best to use pharmaceutical-grade CBD and get in clinical trials, if you can,” he says. “Certainly, if you’re going to try over-the-counter stuff, let [your doctor] know. You have to have a physician who knows about this drug and this class of drugs.”
Dr. Goldstein says about half of her patients with autism benefit, but she is a trained medical professional with a background in both CBD and pediatrics, so she can properly guide them.
Is CBD legal?
According to the National Conference of State Legislatures, CBD is currently legal in 36 states, plus the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. But that’s not the whole story. Right now, CBD is not legal at the federal level: The Drug Enforcement Administration (DEA) still lists marijuana and all its components, including CBD, as Schedule I controlled substances, meaning they have a high potential for abuse.
The Autism Science Foundation has called on the DEA to move medical marijuana from a Schedule I to a Schedule II compound so as to facilitate more research. Remember, however: Just because a CBD product is legal doesn’t mean it’s good quality.
There are no formal guidelines for using CBD products in children with autism. According to the Autism Science Foundation, the lack of research means there’s limited information on the dose schedule, adverse effects, target symptoms or treatment duration. Always weigh the risks and benefits with a doctor.
Aside from Epidiolex, the FDA hasn’t approved any other CBD products, which means commercial CBD products haven’t been evaluated to be sure they contain the levels of CBD stated on the bottle—and don’t have contaminants.
Not all labels list the correct ingredients, which means you could also be exposing your child or yourself to unknown substances, such as THC. Always buy products from a company that has their products tested and validated by third-party labs (more on this below).
Types of products
Commercially available CBD products come in four general categories: creams and other forms you apply to your skin, those you can inhale (vaping), ingestables like capsules and edibles, and sublingual products you absorb under your tongue, says Lee. They differ in how long they take to kick in and how long their effect lasts, among other things.
Each of these products is available in three forms depending on what kind of ingredients they have:
- Full-spectrum CBD: containing all of the components of the hemp plant (Cannabis sativa), including CBD, small traces of THC and terpenes, which are plant compounds
- Broad-spectrum CBD: containing all of the components except THC
- CBD isolates: containing only CBD
How to select a CBD product
It’s best to work with a licensed medical professional or medical dispensary to choose a product. If you still want to try CBD despite the caveats above, “make sure it’s a quality product as best you can and not contaminated,” says Dr. Goldstein. Follow these guidelines:
- Any product you buy should be tested by an independent lab and should have a certificate of analysis (COA) listing the ingredients. Sometimes you can get these through the URL on the packaging.
- Only buy U.S.-grown products.
- Make sure you can contact the company via e-mail or phone.
- Centers for Disease Control and Prevention: "Data & Statistics on Autism Spectrum Disorder"
- National Institute of Mental Health: "Autism Spectrum Disorder"
- Autism Speaks: "Treatments for Autism"
- National Conference of State Legislatures: "State Medical Marijuana Laws"
- Drug Enforcement Administration: "Drug Scheduling"
- Autism Science Foundation: "Statement on Use of Medical Marijuana for People with Autism"
- Gregory Barnes, MD, PhD, neurologist, Norton Children's and University of Louisville
- Autism Speaks: "Is there research on the use of cannabis products with children with autism?"
- Nature: "Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy"
- Frontiers in Neurology: "Effects of CBD-Enriched Cannabis sativa Extract on Autism Spectrum Disorder Symptoms: An Observational Study of 18 Participants Undergoing Compassionate Use"
- UC San Diego Health: "Current Clinical Trial Assessing Potential of CBD in Treatment of Autism"
- Doris A. Trauner, MD, professor, department of neurosciences, UCSD School of Medicine
- American Academy of Pediatrics: "Seizures and Epilepsy"
- Food and Drug Administration: "FDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy"
- Bonni Goldstein, MD, medical director and owner, Cannacenters, and author, Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain
- Martin A. Lee, co-founder and director, Project CBD and author, Smoke Signals: A Social History of Marijuana–Medical, Recreational, and Scientific
- National Library of Medicine: "Cannabidiol (CBD)"
- Autism Science Foundation: "Statement on Use of Medical Marijuana for People with Autism"
- Child Mind Institute: Marijuana and Psychosis