CBD and Autism – What’s the Story?

By James Tindall, PhD

What is Autism?
Autism, or Autism Spectrum Disorder (ASD), is a collection of disorders (very complex ones) that affect brain development. As a “spectrum,” ASD affects individuals to varying degrees. However, generally a person with autism will suffer from communication difficulties, difficulties in social interaction, and repetitive (sometimes self-injurious) behaviors.

While some ASD children may be characterized as having an intellectual disability, there are some (commonly characterized as “high-functioning”) that excel in art, mathematics, and music. For the latter, symptoms can improve with age, however, other ASD children are unable to speak and may engage in self-harming behaviors (as mentioned above).

What Causes Autism?
Until recent years, the answer was, “We don’t know.” While there appears to be single cause, research has shown that autism can be traced to early brain development, within the last few years, researchers have identified many mutations, or rare gene changes, some of which may act as a catalyst for autism. In other cases, autism is potentially caused by a combination of environmental factors and a genetic predisposition that affect early brain development.

The most obvious signs of autism occur between ages 2 and 3 consequently, various groups have been funding research efforts to help detect autism at earlier ages. It has been shown that an early diagnosis may improve the effects of the various treatment options. Additional risk factors can include:

  • Age of a parent (or parents) at time of conception. It has long been assumed that parents above the ages of 35-40 show an increased chance of their child being affected by autism.
  • Maternal illness during pregnancy.
  • Difficulties during pregnancy or birth such as oxygen deprivation to a baby’s brain and other factors.

Thus far, autism management has focused on therapies with drugs, but also include behavioral modification, and social-skills coaching.

Regarding clinical studies on cannabis and autism, there currently are none in the U.S. However, there is a growing body of positive anecdotal evidence from doctors and parents. Since cannabis was outlawed in the United States in 1947, we are far behind research being done in other countries such as Israel. This lack of scientific data in the U.S. keeps doctors from endorsing cannabis for treating autism. However, some promising ancillary research exists. An additional problem is that the many active compounds in cannabis have made proper dosing for children difficult to pinpoint, creating controversy in the medical community over its use.

Therefore, doctors won’t prescribe cannabis to treat autism in children since little to no data exists to support such a course of treatment. And, that research doesn’t exist because of the medical establishment fears about testing cannabis on children. These fears arise because of the many active compounds in cannabis, any of which could be a variable that is scientifically difficult to control—with its many active compounds seen as potentially uncontrollable variables—on children.

Despite this, in the absence of empirical data, there is a growing body of anecdotal evidence that cannabis is making children with autism both happier and healthier. And some doctors, due to the lack of progress in autism research, are listening. As an example, New Jersey allows cannabis in schools for autistic and epileptic teens.

The Center for Disease Control and Prevention (CDC) estimates that 1.5 percent (that’s 1 in every 68 children) in the U.S. have been diagnosed as being on the autism spectrum. This number represents a tenfold increase during the last 40 years. Separating into gender categories, boys are 4 to 5 times more likely to diagnosed with autism than girls.

How to Find a Doctor or Clinic That Specializes in Medical Marijuana Recommendations
Many doctors, although not convinced of the benefits of cannabis for autism treatment state that “Anecdotes should not be dismissed.” One of these is Dr. Daniele Piomelli, one of the world’s top neuroscientists and endocannabinoid researchers and University of California-Irvine faculty member. He and others say that,  “An anecdote is a pointer and often suggests something needs to be either proven or disproven.”

Dr. Giovanni Martinez, a clinical psychologist in Puerto Rico has introduced an alternative therapy of surfing for therapeutic benefits for autism patients. And, Dr. Martinez is researching the therapeutic possibilities of treating children who have autism with CBD oil, and has thus far, reported positive results. In one specific case, a child he treated spoke his first words after receiving a twice-daily spray of hemp oil on the tongue. After three weeks, the child went from being non-verbal to developing significant language skills. Thus, while not specific research proof, it suggests high anecdotal proof that CBD does help those with autism. And, because getting any drug approved for human treatment is a long, arduous process, CBD’s anecdotal proof so far, can ensure that a patient can be ahead of the curve in treatment if they use it. Because there is no toxicity problems and high anecdotal proof, many parents are saying, “Why not?”

What are High CBD Cannabis Strains and How Do They Differ from High THC Strains?
Dr. Martinez also has reported that “initially the child would become so frustrated with his inability to communicate, that he would act out and injure himself. But, now that he can express himself, he laughs and enjoys life. It’s incredible to see a child go from being non-communicative to achieving a significant improvement in quality of life—for both the child and his family.” This was the result of cannabis therapy. Dr. Martinez is convinced it works for some, but research proof is a long ways off – again – the anecdotal approach.

For another example, Mieko Hester-Perez, founder of the Unconventional Foundation for Autism, and advisory board member to Cannabis Science, presents us with a strong case. Growing up in a conservative family, with deep roots in law enforcement, she’s an unlikely cannabis advocate. However, she is also the mother of Joey who is quite unique. This is because Joey is the boy for whom Aaron Justis of Buds and Roses Collective and master cultivator Kyle Kushman developed Joey’s Strain. Following is what happened. Hester-Perez’s was converted to cannabis treatment as an autism therapy when Joey, who has autism, was later diagnosed with Duchenne’s muscular dystrophy. The latter is a rare and aggressively degenerative muscular disorder. He was given six months to live, and in that short period of time, would need to take a cocktail of FDA-approved medications that had a severe degree of documented toxicity – he was already taking up to 13 different meds each day.

After researching less impactful, life-extending alternatives, Hester-Perez came across cannabis. She became extremely curious and experimented by giving her son cannabis-infused edibles. Soon after, Joey began making eye contact, which if you have a child with autism, you know that making eye contact is always a struggle for children with autism, especially on a more consistent basis. The edibles appeared to stimulate Joey’s appetite and he put on weight. Six years passed after that six-month-terminal diagnosis; Joey is a happy, sociable and thriving child.

Despite such results, some professionals in the medical and scientific communities criticized Hester-Perez for treating a child with cannabis. She responded, “Until you’ve walked in my shoes. Until you’ve walked in Joey’s shoes. Until you’ve seen where a child was before cannabis, how much progress they’ve made after cannabis, and how much their lives can improve, who is anyone to pass judgment?” As a note, another draw back for therapy treatment of cannabis, since it is not approved by the FDA, is that there can be high liability for physicians who prescribe a non-approved drug.

What are Current Treatments for Autism?
Each child with autism is unique; what works for one child may have adverse effects in another, which is yet another reason that doctors will not prescribe cannabis. The least controversial treatments for autism are behavioral and often include target social-skills training or parent-led therapy sessions under the supervision of a therapist. Evidence-driven studies demonstrate the benefits of two early behavioral intervention methods, including:

  • The Early Start Denver Model and
  • The Lovaas Model based on Applied Behavior Analysis (ABA).

Other studied and validated behavioral therapies that may be effective include:

  • Floortime
  • Pivotal Response Therapy
  • Verbal Behavior Therapy

As children grow older, other methods may include such as extensive structured and therapeutic activities, social skill development, daily living, motor skills development, and communication coaching. However, the improvement using such therapy methodologies has been inconsistent due to individuality of each autism case.

As you may imagine, there are very few approved medical treatments for autism. In fact, there are currently just two drugs approved by the FDA. One of these is designed to treat irritability associated with autism, however, not one drug has been approved to treat autism’s three core characteristics—communication difficulties, social challenges, and repetitive behaviors.

The two approved medications are:

  • Aripiprazole (brand name Abilify) and
  • Risperidone (brand name Risperdal).

While these two drugs can provide relief from self-injuring behaviors, by reducing irritability, and aggressive outbursts, there can be significant side effects, which include diabetes, significant weight gain, movement disorders, gynecomastia (development of male breasts), and lastly, heart problems.

Cannabis Studies Far Outnumber Most FDA-Approved Pharmaceuticals
There are numerous other medications, which are either “experimental” or “off-label.” Experimental drugs can often carry significant unknown risks while “off-label” drugs are generally only approved for conditions that appear to be related to autism such as depression, sleep disorders, or Attention Deficit Hyperactivity Disorder.

Some of these drugs include:

  • Naltrexone, an FDA-approved medication to treat alcohol and opioid addictions, which has shown success in some patients by alleviating disabling repetitive and self-injurious behaviors;
  • Selective Serotonin Reuptake Inhibitors (SSRIs); and
  • Stimulant medications such as Adderall or Ritalin

You should note however, that there have been no significant clinical trials to demonstrate risk or efficacy of these drugs in children with autism. Additionally, predicting which drug and its dosage may be effective has proven to be extremely problematic.

The Big Question – Can Cannabis Treat Autism?
With each passing day, parents of children with severe autism, become more frustrated with the lack of options. As a result, they are turning to cannabis for a potential treatment. It appears to have no ill effects and many have heard anecdotal reports of success, as well as having read about promising results with epileptic children. Despite this, clinical research remains nonexistent. Oddly, you can find more than 550 clinical studies done outside the laboratory on humans that involve cannabis and that are listed on ClinicalTrials.gov; none of these involve epilepsy or autism. Following are a few promising studies that are much more than anecdotal.

  • A study published in 2013 by Dr. Csaba Foldy at the Second University of Naples in association with Stanford University Medical School found that alterations in endocannabinoid signaling may contribute to autism;
  • According to the Autism Research Institute, some of the symptoms that MMJ have improved include “anxiety, aggression, panic disorder, generalized rage, tantrums, property destruction, and self-injurious behavior;”
  • Daniele Piomelli and Dr. Olivier Manzoni discovered that certain chemicals found in cannabis can help behavioral issues in children with autism or Fragile X syndrome;
  • Dario Siniscalco in 2013 found indications that certain compounds, specifically the CB2 receptor, found in cannabis can be helpful in managing autism; and
  • Piomelli has presided over some groundbreaking discoveries, including the potential of cannabinoids. One specifically, anandamide, and endocannabinoid, was demonstrated to be useful for autism treatment by regulating social reward.

How the Endocannabinoid System Impacts Your Brain’s Response to Social Interaction?
Piomelli and team discovered that endocannabinoids appear to be important in regulating normal social behavior; they are also potentially involved in the dysfunctional behavior that accompanies certain forms of autism spectrum disorders. “The endocannabinoids offer hope that one could, by interfering particularly with their destruction and by boosting their activity, normalize social behavior in children with autism,” Piomelli said.

What is the Risk of Cannabis Therapy?
Science is driven by data; because of this, few doctors or researchers are willing to recommend cannabis to treat autism. In contrast to epilepsy, which has references dating back as far as 1843, there just isn’t a sufficient body of evidence for most physicians to feel comfortable recommending cannabis as a treatment. Not to mention, as mentioned before, that prescribing an unapproved drug not on the FDA approved list, can bring severe penalty and liability to the physician, including loss of license, fines, and jail time. So, until research is enough to prove cannabis viability to the FDA, it is unlikely you will find physicians that will prescribe cannabis for your autistic child.

Additionally, Piomelli cautions that dosing can be problematic, that many parents may not be equipped to assess or monitor proper dosing, and that attempting to do so without the guidance of a qualified professional could have serious consequences: “Pharmacology is all about doses. Low doses can be good, while high doses can be bad. One thing people need to understand is that if the endocannabinoid system has a protective role, it doesn’t mean that activating this system may not be harmful.” He cautions there is a possibility one risks “messing up the endocannabinoid system. Even though the intent is to enhance social behavior, one may end up having the opposite effect. “Further, because we’re dealing with plants, there are added layers of complexity. Whereas, with most pharmacological drugs, there is usually a single active compound to treat a condition, cannabis contains potentially hundreds. This can be a good thing or a bad thing. Many attribute the efficacy of cannabis to an entourage effect, or a synergy between ingredients. While this may be an overall positive, it doesn’t lessen the complexity of determining which component may be helping, and which may be counterproductive or harmful.”

The Cannabis’ Entourage Effect – Whole Plant Medicine Matters
Piomelli, like most doctors, would not recommend cannabis as a treatment, because there is little scientific research to base it on. Unlike epilepsy, the research on autism is in the beginning stages. However, recognizing that parents who’ve tried everything see cannabis as a last defense, “I certainly would not pass judgment on a parent who is desperate and would do it. I’m just saying be very, very careful what you do.”

Other professionals privately admit that for parents who feel they’ve exhausted all other options, the unknowns and potential risks may be acceptable. According to the late Bernard Rimland, founder of the Autism Society of America and former director of the Autism Research Institute, “the benefit/risk profile of medical marijuana seems fairly benign” when compared to Risperdal or what Dr. Rimland considers the least useful and most dangerous: psychotropic drugs.

“Moreover, the reports we are seeing from parents indicate that medical marijuana often works when no other treatments, drug or non-drug, have helped,” Rimland added.

As the author and being a scientist myself, I can tell you that it takes years for research to be accepted. If you recall the tectonic-plate theory, despite overwhelming evidence and research, it took 30 years before the general scientific community accepted the theory. Research on cannabis is not likely going to be any different. Thus, if you are one of those parents who are desperate to try something else, cannabis, as Piomelli and Rimland above state, could be a viable option. One caution I would advise is this: people often think that if a little is good, more is great – do not take this approach if you decide to explore the cannabis option. Begin with very small doses and take time to determine what effect that may have and, do your own research to find out what other parents are giving in terms of dose. You must bear in mind however, that your child is uniquely different and what may work for another child, may not work for yours.

References
Chakrabarti, B., Persico, A., Battista, N. et al. Neurotherapeutics (2015) 12: 837. https://doi.org/10.1007/s13311-015-0371-9

Maccarrone M, Bab I, Bíró T, et al. Endocannabinoid signaling at the periphery: 50 years after THC. Trends Pharmacol Sci 2015;36:277-296.PubMedCrossRefGoogle Scholar

Maccarrone M, Guzman M, Mackie K, Doherty P, Harkany T. Programming and reprogramming neural cells by (endo-)cannabinoids: from physiological rules to emerging therapies. Nature Rev Neurosci 2014;15:786-801.CrossRefGoogle Scholar

Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature 1990;346:561-564.PubMedCrossRefGoogle Scholar

Pacher P, Kunos G. Modulating the endocannabinoid system in human health and disease-successes and failures. FEBS J 2013;280:1918-1943.PubMedCentralPubMedCrossRefGoogle Scholar

Others not listed