Autism Spectrum Disorder (ASD) is one of the most prevalent neurodevelopmental disorders, affecting between 10 and 20 people per 10,000—though some estimates put that number closer to 72 per 10,000. It is also very difficult to manage, as its treatment usually involves a wide range of social, communicative, physical, and medicinal therapies—and this is just to treat the core symptoms.
What makes ASD even trickier is its wide range of common comorbidities – conditions which occur simultaneously – which range from other mental disorders like ADHD and depression, to physical ones like epilepsy and sleep disruption. While trying to treat these disorders ASD patients often ingest cocktails of pharmaceuticals, each with their own list of side effects. Many people with ASD and their loved ones are constantly asking: isn’t there something better they can take?
In this article, we will explore the effectiveness of CBD as a potential treatment for ASD. In addition to investigating and illuminating the scientific literature available on such treatments, we will also briefly examine CBD’s usefulness in treating some of Autism’s most common comorbidities: ADHD and seizures.
The Help of CBD with Autism
The body’s endocannabinoid system—a system composed of endocannabinoids and endocannabinoid receptors. Cannabinoid receptors are complex protein structures on the surfaces of cells that permit communication and interaction between substances outside the cell and substances within—they are part of the cellular communications network.
Cannabinoids are plant substances that fortuitously interact with human endocannabinoid receptors; the cannabinoid is like a key, the receptor-like a lock that only specific keys fit into. So far scientists are aware of and focus on two main cannabinoid receptors in the body: CB1 receptors concentrated primarily in the central nervous system, and CB2 receptors located mostly in immune and gastrointestinal cells.
Substances that bind to these receptors fall generally into three categories:
– Endocannabinoids which are naturally produced in the human body –examples include Anandamide (AEA) and 2–Arachidonoylglycerol (2AG)
– Phytocannabinoids, naturally produced by cannabis species including hemp. There are hundreds of phytocannabinoids found in Cannabis species.
– Cannabimimetics which can come from a variety of plants and imitate or mimic some effects of phytocannabinoids from Cannabis species.
– Anandamide (AEA) and 2–Arachidonoylglycerol (2AG) are the two most prevalent endocannabinoids produced in the body, while delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most abundant cannabinoids found in marijuana.
Scientifically, AEA has been found to serve an important role in several behavioral functions pertinent to ASD in non-ASD brains. These include cognitive function, emotional regulation, social functioning, motivation, and reward processing. Unsurprising, recent evidence is revealing a lower concentration of AEA in people with ASD compared to those without. One study conducted on 112 children (59 with ASD, 53 without) showed “significantly lower” AEA concentrations on those afflicted with ASD.
So, if we know that people with ASD have lower AEA levels, and we know that phytocannabinoids like CBD act on the same receptors as endocannabinoids like AEA, then the question becomes: what may CBD be doing—and is it beneficial—in people with ASD?
Science Evidence Treating ASD with CBD
Though research into treating ASD with CBD is relatively limited, there are a few studies available that show promising results
Approximately 50 percent of children with ASD suffer from behavioral problems such as tantrums, self-injury, and violence. A study conducted in Israel compared a trial treatment of a combination of CBD and THC on 60 children with ASD between the ages of five and 18 (average of 11.8) years old who suffered from such “refractory disruptive behaviors.
Each child was given a starting dose of plant extracts with 20:1 CBD-to-THC ratios, which were then adjusted according to each child’s reactions in the months to follow. The study itself was designed to last for 13 months, and the outcomes were measured with 4 questionnaires.
Results from this study indicated significantly positive results. Using the CGIC questionnaire, considerable improvement in behavior problems was reported in 61% of the children, while 39% showed improvement in anxiety and 47% showed improvement in communication. HSQ-ASD scores also improved by 29%, and APSI scores improved by 33%.
This study included 18 patients with ASD, aged between 6 and 17 years old. Patients were put on a regimen of daily cannabis extracts with 75:1 CBD-to-THC ratios, with the dosing sizes adjusted on a per-patient basis within the first thirty days.
The success of the treatment was evaluated using a questionnaire designed by the scientists conducting the study, which asked parents to evaluate eight different symptom categories for improvement or worsening
Parents filled out the questionnaire once per month, as well as supplementary forms designed to ensure that the parents fully understood what each category evaluated. The patients’ physicians would then check the parents’ scores for consistency. If the physicians felt that the parents’ reports were inaccurate, they would recommend an adjustment to their response.
At the end of nine months, researchers reported mostly positive outcomes. Fourteen out of the fifteen patients had their parents report improvements of 30% or more in at least one of the evaluated criteria, and nine of these had improvements of 30% or more in multiple categories. Sleep disorders and ADHD behavior were the two most improved upon symptoms, with median improvements of 40 and 30% (respectively). What’s more, every category had a median improvement of at least 10%.
More than anything, these two studies suggest that CBD should be taken seriously as a potential approach for ASD—and that more research into this potential is worthwhile.
Though two studies with somewhat small sample sizes are insufficient to make any claims with certainty, they are enough to justify considering CBD as a valid treatment option for people who suffer from ASD. If CBD can help ASD patients behave and sleep better while simultaneously reducing their parents’ stress levels for the few dozen families in these trials, then it is possible that others may benefit as well.
Though ASD has far too many comorbidities to address in full here, it’s worthwhile to address at least two of the major ones: ADHD and epilepsy. As you probably noticed in the second study, ADHD was one of the symptom categories evaluated. This is because more than half of all people with ASD show signs of ADHD, while around 15 % have diagnoses for both.
Though little research has been conducted into the efficacy of treating ADHD with CBD, one study conducted on 30 adults with ADHD showed promising results. The active group outperformed the placebo group in both the primary and secondary outcomes of the study. These were cognitive performance and activity level, and ADHD and emotional lability symptoms, respectively. Epilepsy, on the other hand, is the only FDA-approved disorder for cannabis treatment—which is pertinent to ASD, because between 10 and 30% of ASD patients have comorbid epilepsy.