CBD as a treatment for autism.
Summary : The administration of cannabis extracts rich in CBD is safe and effective in mitigating symptoms in children with autism spectrum disorder (ASD), according to data from randomized, placebo-controlled clinical trials published in the journal Trends in Psychiatry and Psychotherapy.
Autism spectrum disorder (ASD) refers to a group of neurodevelopmental disorders, whose symptoms include problems with communication and social interaction with restricted or repetitive motor movements. In some cases, it may also be associated with general cognitive deficits. Although ASD can be diagnosed at any age, it is defined as a «developmental disorder» because symptoms usually manifest within the first two years of life. Autism is known as a spectrum disorder because its symptoms can range from mild to debilitating.
Modulation of the endocannabinoid system has been suggested as a target of ASD therapies,[1] and children with ASD have been found to possess lower than normal levels of certain endogenous cannabinoids, including anandamide.[2]
In recent years, a growing number of human studies and case reports have documented improvements in patients with ASD following administration of various cannabinoid formulations.[3]
For example, a 2019 Brazilian observational trial reported that twice-daily administration of plant-derived CBD extracts was associated with an improvement in ASD symptoms in 14 of 15 adolescent subjects.[4]
A number of Israeli trials have also documented favorable results. In 2018, researchers reported to the journal Neurology that administering CBD-dominant cannabis extracts led to significant improvements in more than 60% of patients with ASD and refractory behavioral problems.[5]
A 2019 study involving 188 patients reported that more than 90 percent of subjects administered CBD-dominant extracts over a period of at least six months demonstrated «some level of symptomatic improvement.» About a third of respondents reported a reduction in the intake of other medications. The authors concluded: «Cannabis as a treatment for patients with autism spectrum disorders appears to be well tolerated, safe, and [an] effective option for relieving symptoms, primarily: seizures, tics, depression, restlessness, and angry outbursts.»[ 6]
Another Israeli trial completed the same year similarly reported that the use of CBD extracts resulted in «overall improvements» in a cohort of 53 children with ASD.[7]
In 2020, American researchers affiliated with Tufts University in Boston reported on their clinical experience working with children and young adults with ASD who had used cannabis or hemp-based products. Among subjects with ASD-associated aggression, 60% reported improvements after treatment. Among subjects diagnosed with ASD and epilepsy, 91% reported some improvement in seizure control.[8]
The following year, Canadian researchers documented the successful treatment of a 15-year-old patient with autism after adding low doses of CBD/THC extracts on a complementary basis. The researchers reported that the patient’s symptoms improved within six months of treatment and that she had experienced «positive effects on her behavioral symptoms, anxiety, sleep, and social deficits» since then.[9]
More recently, a placebo-controlled clinical trial reported that administration of whole-plant cannabis extracts was safe and effective in a cohort of 150 adolescents with autism. The researchers reported: “In this study, we have demonstrated for the first time in a placebo-controlled trial that cannabinoid treatment has the potential to decrease disruptive behaviors associated with ASD, with acceptable tolerability. … Disruptive behavior on the CGI-I [Clinical Global Impression Improvement Scale] improved very or very much in 49 percent [of subjects taking] whole plant extract versus 21 percent in placebo. The median SRS [Social Responsiveness Scale] total score (secondary outcome) improved by 14.9 [points] with the whole plant extract compared to 3.6 points after placebo.”[10]
Una revisión de 2021 de la literatura relevante resumió: “Se ha demostrado que los productos de cannabis reducen el número y/o la intensidad de diferentes síntomas, que incluyen hiperactividad, ataques de automutilación e ira, problemas para dormir, ansiedad, inquietud, agitación psicomotora, irritabilidad, agresividad, perseverancia y depresión. Además, [están asociados con una] mejora en la cognición, la sensibilidad sensorial, la atención, la interacción social y el lenguaje”. Los autores concluyeron: «El cannabis y los cannabinoides pueden tener efectos prometedores en el tratamiento de los síntomas relacionados con los TEA y pueden usarse como una alternativa terapéutica para el alivio de esos síntomas».[11]
[1] Zamberletti et al. 2017. The endocannabinoid system and autism spectrum disorders: Insights from animal models. International Journal of Molecular Sciences 18: 1916 [open access journal].
[2] Aran et al. 2019. Lower circulating endocannabinoid levels in children with autism spectrum disorder. Molecular Autism 10 [open access journal].
[3] da Silva et al. 2021. Cannabis and cannabinoid use in autism spectrum disorder: A systematic review. Trends in Psychiatry and Psychotherapy [open access journal].
[4] Fleury-Texeira et al. 2019. Effects of CBD-enriched cannabis sativa extract on autism spectrum disorder symptoms: An observational study of 18 participants undergoing compassionate use. Frontiers in Neurology 10 [open access journal].
[5] Aran et al. 2018. Cannabidiol-based medical cannabis in children with autism: A retrospective feasibility study. Neurology 90.
[6] Bar-Lev Schleider et al. 2019. Real life experiences of medical cannabis treatment in autism: Analysis of safety and efficacy. Scientific Reports 9: 200.
[7] Barchel et al. 2019. Oral cannabidiol use in children in with autism spectrum disorder to treat related symptoms and co-morbidities. Frontiers in Pharmacology 9: 1521.
[8] Mostafavi and Gaitanis. 2020. Autism spectrum disorder and medical cannabis: Review and clinical experience. Seminars in Pediatric Neurology 35 [online publication].
[9] Andrea-Ponton et al. 2021. A pediatric patient with autism spectrum disorder and epilepsy using cannabinoid extract as complementary therapy: A case report. Journal of Medical Case Reports [open access journal].
[10] Aran et al. 2021. Cannabinoid treatment for autism: A proof-of-concept randomized trials. Molecular Autism 12 [open access journal].
[11] da Silva et al. 2021. Op. cited
