Promising results in recent studies give hope that CBD could help improve autism symptoms as efficiently as it helps children who suffer from rare forms of epilepsy.
Autism spectrum disorder (ASD), commonly known as autism, is a term used to describe a combination of impairments in social communication followed by repetitive behaviors, highly restricted interests, and/or sensory behaviors beginning early in life. The worldwide prevalence of this neurodevelopmental disorder is just under 1%, but estimates are higher in high-income countries. The World Health Organisation (WHO) approximates that about one in 270 people worldwide has ASD, but some well-controlled studies have reported substantially higher figures.
In 2018, a group of Israeli scientists published a study in Neurology, with the findings showing CBD oil reduces autism-induced behavioral, communication, and anxiety problems in children. That was one of the first reports on the impact of CBD-rich medical cannabis in children with ASD, and the results supported further trials of CBD-based cannabis in children with ASD.
A breakthrough study
Between March 2016 and January 2017, 60 children referred by the Shaare Zedek Medical Center in Jerusalem were medically approved to use cannabis and were systematically investigated after 7–13 months of treatment. The cannabis was given as a secondary therapy, upon parental request, following specific individual approval of the Israeli Ministry of Health. All children were prescribed whole-plant extracts that contain CBD and THC in a 20:1 ratio, dissolved in olive oil. The cannabis oil was given sublingual two to three times a day with doses up-titrated over 2–4 weeks, to effect and tolerability (starting CBD dose was 1 mg/kg/day, maximal CBD dose was 10 mg/kg/day).
Out of 60 children aged 5–18 years (83% were boys), forty-nine (82%) were treated with medications and cannabis at the same time: 43 children (72%) used antipsychotics, 10 (17%) received mood stabilizers, 7 (12%) received benzodiazepines, 4 (7%) received selective serotonin reuptake inhibitors, and 4 (7%) received stimulant. Following the cannabis treatment, 16 (33%) received fewer medications or lower dosages, 12 (24%) stopped taking medications, and 4 (8%) received more medications or higher doses.
Overall improvement in 74.5%
After the parents rated the overall improvement, considerable improvement in behavior problems (‘much improved’ or ‘very much improved’) was reported in 61% of the children. Considerable improvement in anxiety was reported in 39%, and considerable improvement in communication problems was reported in 47% of the children.
Adverse events included sleep disturbances (14%) irritability (9%) and loss of appetite (9%). One girl who used higher tetrahydrocannabinol had a transient serious psychotic event that required treatment with an antipsychotic. Following the cannabis treatment, behavioral outbreaks were much improved or very much improved in 61% of patients.
In 2019, another Israeli study was published on the subject of oral CBD use in children with ASD. In this study, 53 children at a median age of 11 years received CBD for a median duration of 66 days. The scientist evaluated four ASD comorbidity symptoms: hyperactivity symptoms, sleep problems, self-injury, and anxiety.
Recommended daily dose of CBD was 16 mg/kg (maximal daily dose 600 mg), and for THC- a daily dose of 0.8 mg/kg (maximal daily dose of 40 mg). As a result, self-injury and rage attack improved in 67.6% and worsened in 8.8%. Hyperactivity symptoms improved in 68.4%, did not change in 28.9%, and worsened in 2.6%. Sleep problems improved in 71.4% and worsened in 4.7%. Anxiety improved in 47.1% and worsened in 23.5%. An overall improvement was reported in 74.5%. No change was reported in 21.6% and worsening in 3.9%. Adverse effects, mostly somnolence and change in appetite, were mild.
CBD is not inferior to conventional treatments
Comparing these findings with the improvement using conventional treatments, the scientists have concluded that CBD is not inferior to commonly used drugs. When it comes to self-injury and rage attacks, the improvement of the symptoms as a result of conventional therapy with atypical antipsychotics like aripiprazole is 82%. Hyperactivity symptoms can be improved with conventionally used methylphenidate in 80%. Melatonin improved sleep problems in 60% of the patients. The anxiety symptoms improve with selective serotonin reuptake inhibitors (SSRIs) treatment in 55–73%.
Patients with a history of psychotic attacks are more likely to develop cannabis-induced psychotic attacks, and this should be a contraindication for treatment with CBD, warned the scientist.
A study conducted in Brazil in 2019 on 15 children administrated 175 mg CBD per day with 2,33 mg THC per day found over 30% improvement in a range of symptoms, with a higher rate of improvement in those children who did not suffer from epilepsy. Again, the highest improvement on average was observed in seizures and sleep disorder, with two participants reporting 100% improvement in the seizures.
A Systematic Review of Published and Ongoing Studies on Cannabinoids for People with ASD published in Brain Sciences in 2020 outlines that epilepsy is one of the most frequent co-occurring conditions of ASD. In 2019, the US Food and Drug Administration (FDA) approved the Epidyolex, a CBD-based oral solution, for the treatment of seizures in two rare forms of epilepsy – Dravet and Lennox-Gastaut syndrome for children older than two years of age. The presence of seizures or non-epileptic abnormalities in EEG patterns might be partially responsible for the challenging behaviors or aggression in people with ASD, and the common co-existence of ASD and epilepsy suggests the presence of shared neuropathological mechanisms. The correction of these abnormalities could improve the behavioral problems in children with autism.