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CBD Oil and Autism: What Parents Need to Know

CBD oil is becoming an increasingly popular treatment option for a variety of health conditions – including autism. But is CBD oil a safe autism treatment for kids?

Autism is a neurological disorder impacting social skills and development. It affects one in 40 American children today, according to a December 2018 report from the American Academy of Pediatrics. Many children with autism have difficulty interacting with others, and some display unusual patterns of behavior like ritualistic motions. Individual cases of autism fall on a spectrum ranging from mild to severe.

Doctors don’t know the cause of autism, but environmental and genetic factors may play a role. There’s also no cure for autism; however, a variety of interventions (like occupational and speech therapies) can lessen the severity of symptoms. One of the newest and most controversial treatment options is cannabidiol (CBD) oil, a natural substance extracted from cannabis.

  • RELATED:Is CBD Oil Safe for Kids?

CBD oil is made without large amounts of tetrahydrocannabinol (THC) – the chemical that’s responsible for the psychedelic effects of marijuana – so it can’t technically get you “high.” It has become widely available in health food stores and medical marijuana dispensaries across the country – usually in liquid, cream, or gel capsule form.

In preliminary studies, CBD oil has been shown to improve a variety of physical and mental health conditions like chronic pain, anxiety, ADHD, gastrointestinal illness, insomnia, cancer, and more. And in an April 2018 study of 60 children published in Neurology, a group of Israeli researchers found that CBD oil reduced autism-induced behavioral, communication, and anxiety problems.

Parents across the country have hopped on these findings and starting giving CBD oil to their children. Many claim CDB oil helps regulate emotions, promote better sleep, and control autism symptoms.

As with every new medical breakthrough, though, CBD oil isn’t without drawbacks. According to Mandi Silverman, PsyD, MBA, senior director of the Autism Center at the Child Mind Institute, there’s a lack of information about using CBD for behavioral disorders, especially in young children. That’s why Silverman and many other health professionals suggest parents learn the facts before stocking up on CBD oil.

  • RELATED:Signs of Autism in Toddlers

“As parents, we give ourselves the daunting task of fixing everything. When your child is diagnosed with a developmental disorder like autism, the desire to fix things is even more exaggerated,” she says. “Treatment for autism takes time. Parents see CBD oil as this option that can address some of the needs in a way nothing else can.”

But despite how tempting CBD oil may be as an autism treatment, Silverman says it’s “not an intervention with an evidence base.” It’s also not an FDA-approved method for treating autism.

Here are a few more issues surrounding the treatment of autism with CBD oil:

No clinical trial has analyzed the effects of treating CBD oil with autism, so doctors aren’t sure about safety. It’s also unclear exactly how CBD is absorbed into the body.

You can’t know the exact amount of CBD in your oil. The concentration of ingredients may differ in each batch, says Silverman.

CBD oil products aren’t lab tested in every state, according to the Child Mind Institute, so they could potentially contain THC or other unknown items.

CBD oil may interact with other medications.

Side effects, like drowsiness and dry mouth, may be possible.

Some parents may also wonder about the legal issues regarding CBD oil. Some states allow CBD oil as long as it’s derived from hemp, but not from marijuana. Other states outlaw CBD altogether, and some permit it for certain uses. Research your own state’s legislation for more details.

So what’s the bottom line? If you’re considering treating your child’s autism with CBD oil, thoroughly research the positives and negatives. Talk to your child’s doctor – or someone who is well-educated in using CBD oil for medical purposes. And when it comes to choosing products, try finding out how much THC it contains. It’s always best to be an informed consumer when making decisions regarding your child’s health.

CBD oil is becoming an increasingly popular treatment option for a variety of health conditions – including autism. But is CBD oil a safe autism treatment for kids?

Cannabis and autism, explained

by Peter Hess / 7 September 2020
This article is part of:
Autism 101
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Science & Society, Treatments
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Over the past decade, autistic people and their families have increasingly experimented with medical marijuana and products derived from it. Many hope these compounds will alleviate a range of autism-related traits and problems. But scientists are still in the early stages of rigorous research into marijuana’s safety and effectiveness, which means that people who pursue it as treatment must rely mostly on anecdotal information from friends and message boards for guidance.

Here we explain what researchers know about the safety and effectiveness of cannabis for autism and related conditions.

What is medical marijuana?
Medical marijuana generally refers to any product derived from cannabis plants — including dried flowers, resins and oils — that has been recommended by a doctor. It may be consumed directly or infused into an array of foods, lozenges and candies. These products have become popular among autistic people and their families for treating a broad swath of conditions, including insomnia, epilepsy and chronic pain.

Depending on the strain of the plant and the processing methods used, these products contain varying levels of active ingredients, including tetrahydrocannabinol (THC) — responsible for the ‘high’ associated with marijuana — and cannabidiol (CBD), which is minimally psychoactive. Much of the research on medical applications focuses on CBD. There are also more than 500 other compounds in marijuana that may affect people’s behavior and cognition 1 .

Is medical marijuana legal?
Yes and no. Federal law in the United States classifies marijuana and its derivatives as ‘Schedule 1’ drugs, meaning that they have no accepted medical use and a high potential for abuse. Schedule 1 drugs are illegal, and research on them requires labs to follow strict security protocols and adhere to regular facility inspections.

In 33 states, along with the District of Columbia and Puerto Rico, however, people can legally buy and use medical cannabis for certain approved conditions, such as seizures and sleep problems, although the list of qualifying conditions varies by state. These same states, plus 13 others, also allow CBD oil. Fourteen states plus Puerto Rico have approved medical marijuana for autism, and some additional states may allow it for autistic people at a doctor’s discretion.

Under U.S. federal law, CBD products manufactured from industrial hemp are legal as long as they contain no more than 0.3 percent THC. And in some states, CBD oil is permitted to contain up to 5 percent THC.

In many states where medical marijuana is legal, licensed dispensaries sell products that have been tested by accredited laboratories to verify the presence of active ingredients and the absence of contaminants. Some states permit individuals or their licensed caregivers to grow their own cannabis plants for personal use. Most states in the U.S. require people who use medical marijuana to register and get a special identification card.

In many European countries, as well as in Australia, Canada, Israel and Jamaica, medical cannabis is legal, with specific laws varying from country to country.

Are there any cannabis-derived drugs approved to treat autism or related conditions?
To date, the U.S. Food and Drug Administration has approved only one cannabis-derived drug: Epidiolex. It is a liquid cannabis extract containing purified CBD that can decrease seizures in people with Dravet syndrome or Lennox-Gastaut syndrome — severe forms of epilepsy that are sometimes accompanied by autism — and in those with tuberous sclerosis complex. It is available only by prescription, and only for these three conditions.

GW Pharmaceuticals, the company that makes Epidiolex, is conducting a trial of the drug for Rett syndrome, a neurodevelopmental condition related to autism. The Rett syndrome trial is not focused on alleviating seizures, but on improving cognitive and behavioral problems. The company is also recruiting autistic children and teenagers for a phase 2 trial of cannabidivarin, another component of cannabis. That trial will examine cannabidivarin’s effect on a range of traits in autistic children, including repetitive behaviors, and on quality of life.

How might cannabis help autistic people?
Epidiolex’s success has spurred many parents to try marijuana and cannabis extracts for seizures, behavioral issues and other autism-related traits in their children, but experts warn that these drugs remain largely untested for such purposes. Some studies on cannabinoids have shown promising results in animal models and in early-stage clinical trials, but this research does not yet support their widespread use.

Cannabis’ active ingredients are thought to exert their effects by binding to proteins called cannabinoid receptors in the brain: THC activates the CB1 and CB2 receptors, whereas CBD seems to block them 2 .

Both types of cannabinoid receptors are located in neurons in the brain and throughout the body. The brain contains more CB1 than CB2 receptors, and the activation of each receptor type affects a range of ion channels and proteins involved in cell signaling 3 . The ultimate effects of cannabinoid receptor activation depend on which body system they belong to. For instance, the activation of CB1 receptors in the brain can either increase or decrease neuron excitability, depending on which kind of neuron a cannabinoid binds to; activation of CB2 receptors in the digestive system can decrease inflammation 4,5 .

Blocking the CB1 receptor can relieve seizures and memory issues in a mouse model of fragile X syndrome, a condition related to autism, according to a 2013 study in Nature Medicine 6 . A 2018 clinical trial of a synthetic CBD drug by the drug maker Zynerba showed significant improvements in anxiety and other behavioral traits in people with fragile X. Cannabinoid receptor activation has also been shown to lead to memory improvements in fragile X mice 7 .

Research has also demonstrated that CBD alleviates seizures in children with CDKL5 deficiency disorder, an autism-linked condition that is characterized by seizures and developmental delay. CBD also lessens seizures and improves learning and sociability in a mouse model of CDKL5 deficiency disorder.

Complicating the picture, CBD alone may not be sufficient for cannabis’ therapeutic effects. A 20-to-1 ratio of CBD to THC relieves aggressive outbursts in autistic children, a 2018 study suggests 8 . This same ratio of compounds significantly improved quality of life for some children and teenagers with autism in a 2019 study 9 . Specifically, researchers observed significantly fewer seizures, tics, depression, restlessness and outbursts. Most participants reported improvements, and about 25 percent of participants experienced side effects such as restlessness.

Cannabis may have effects that go beyond the cannabinoid receptors, too. Mice that ingested CBD over extended periods of time displayed changes to DNA methylation in sections of the genome associated with autism, a 2020 study showed 10 . The researchers suggested that epigenetic changes may be at least partly responsible for CBD’s behavioral effects, though they did not directly examine the mice’s behavior.

Is cannabis safe?
It’s unclear. Large doses are usually not fatal, but taking it regularly may have long-term effects.

Based on the clinical trials of Epidiolex, the FDA warns that the drug could cause elevated liver enzymes, which can be a sign of liver damage. This is especially likely in people who take Epidiolex and the epilepsy drug valproate at the same time.

CBD is considered minimally psychoactive, but many preparations of it contain undisclosed amounts of THC, which may lead to inadvertent intoxication and impairment.

Many studies have shown that cannabis treatment carries only minor side effects such as sedation or restlessness, but these studies have not looked at long-term side effects. Researchers still don’t have a solid grasp on how the active ingredients in marijuana actually affect the brain, nor do they know how these compounds might impact a child or teenager’s developing brain or interact with other medications.

Some research has shown that recreational marijuana use beginning in one’s teenage years can have negative long-term effects on cognition 11 . But experts note that the dosages used for medical purposes are often quite lower than those used in a recreational context.

Are some cannabis products safer or more effective than others?
Many people who self-administer cannabinoids for epilepsy or other conditions cultivate it at home. Others purchase it directly from companies rather than buying it at state-licensed dispensaries, and research has shown that these products are not created equal.

The actual potency of CBD products varies widely from their advertised concentrations, according to a 2017 study in JAMA, and some products contain more than the legal limit of THC — potentially enough to cause intoxication, especially in children 12 . Less than one-third of the products tested contained within 10 percent of the advertised CBD concentration, and THC was detected in about 21 percent of samples.

In a presentation at the 2020 meeting of the American Academy of Neurology, researchers concluded that ‘artisanal’ CBD products available for purchase online and in health-food stores are not as effective at controlling seizures as pharmaceutical-grade CBD.

Autistic people and their families are increasingly experimenting with marijuana to try to ease problems such as insomnia, epilepsy and chronic pain — and traits of autism. But there is little evidence for its safety or effectiveness.