Cannabinoids and autism spectrum disorder (ASD)
By Mariano Garcia de Palau
Born in Barcelona, 17 February 1956. Graduated in medicine and surgery from the University of Barcelona in 1979. For 38 years has worked as an emergency physician in the area of occupational medicine. He became interested in cannabis by chance, and for the last 15 years has studied its therapeutic uses. He currently works at Kalapa Clinic, where he advises on treatments with cannabinoids, performs clinical work with patients and collaborates with different organisations and associations such as Catfac. He is a member of the Spanish Observatory for Medicinal Cannabis. He is a regular member of IACM.
Autism can be described as a disorder of neurodevelopment, causing alterations in social interaction and with the subject’s surroundings. It also causes problems with verbal and non-verbal communication, and sometimes very restricted and usually repetitive behaviour.
Parents usually start to become aware of these features during the first two years of life. However, this may depend on the degree of autism, which can vary from very mild in some cases to extreme in others.
This variability —as well as other features discussed below— has led to the development of the concept of Autism Spectrum Disorder (ASD). This category encompasses three types of disorder with separate and distinguishable characteristics, namely autistic disorder, Asperger’s syndrome, and PDD-NOS (Pervasive Developmental Disorder-Not Otherwise Specified). Diagnosis can sometimes prove very difficult and be complicated by the degree of autism and a correlation with other pathologies, such as refractory epilepsy.
Autism per se (autistic disorder) involves retardation in cognitive development; this is not the case, however, with Asperger’s syndrome, where numerous cases have been reported of patients with above-average cognitive performance; some individuals are even exceptionally gifted at performing certain mental tasks.
The causes of this disorder are not known with any certainty. Although there are different theories, we do know that there is a proven genetic predisposition. ASD has been related to the so-called fragile X syndrome. However, it is not known whether other chromosomal changes might also be causes or contributors.
Other causes that have been reported include the MMR vaccine, use of paracetamol, food and environmental factors and celiac disease.
Neurotransmitters such as dopamine, serotonin, tryptophan and oxytocin might also be involved.
We know that the endocannabinoid system (ECS) is involved in regulating the processes that are altered in these disorders. One might therefore consider that phytocannabinoids (plant-extracted cannabinoids) might help treat the symptoms of ASD.
We can give some idea of what everyday life for autistic children and the people around them by describing their behavioural and empathic characteristics.
They reject physical contact; there is either no or only very brief eye contact; they do not respond to their parents’ facial gestures; they do not point to objects or actions to draw attention to them or look at objects that their parents point to; they do not properly use facial expressions to show feelings; they show no kind of concern for others; they normally do not have friends and show no interest in making them.
At 16 months, they are normally still unable to say isolated words. They do not point at objects they need or share with others. They tend to repeat what others say without understanding the meaning; they do not usually answer to their names, though they sometimes respond to other sounds. They appear to be uninterested in communicating.
In many cases, they make repetitive movements with their head, arms or hands and suck their fingers.
These children suffer great frustration because they cannot convey and express their emotions. In many cases they have no verbal language, but probably do want to communicate. Imagine living like that.
In cases of severe autism, many children and adolescents display unstable and aggressive behaviour, often including self-harming. This causes major problems for keeping them under control, often necessitating the use of neuroleptic drugs or benzodiazepines to solve behavioural issues.
Prospects for use of phytocannabinoids
As we have said, the ECS is involved in controlling these processes; as early as the foetal period it regulates the essential processes related to neuron differentiation and synapse positioning.
Some studies have shown that ECS CB1 receptors —the most common in the central nervous system— show functional alterations in the cerebral regions involved in autism, such as the hippocampus and basal ganglia.
If this is one of the causes (or a decisive factor) in ASD, the most appropriate cannabinoid might be thought to be THC, since there are also studies that implicate the CB2 receptor in ASD.
THC is the cannabinoid that acts by way of these two receptors, CB1 and CB2.
However, cannabidiol or CBD has been shown to be of great interest for intervention in ASD. Its mechanisms of action differ from those of THC, although they both act on GPR55 receptors and also on transient receptor potential vanilloid (TRPV). All of these receptors are also found in the central nervous system.
The effect of CBD is very unusual. As we have said, many children with ASD display aggressive behaviour and often self-harm. The “conduct normalising” effect is of great interest, since there are no signs of sedation; patients remain properly alert and have no difficulty remaining so. However, in many cases their behaviour is stabilised (though I must reiterate that it is always necessary to assess the severity of the patient’s condition).
Some patients acquire skills they had either lost or never had, such as getting dressed on their own, interacting with the tablet, listening to music and paying attention to their surroundings when out walking. They are less inclined to reject physical contact and may even give hugs, possibly for the first time in years. Their facial expressions improve and they can hold eye contact.
Many children with ASD seem to be unhappy and to be in constant pain or suffering. However, once they start treatment this situation appears to change — or at least improve. Some smile or even laugh!
These changes might seem trivial, but for the children’s parents, they are a major breakthrough and offer some glimmer of hope where none had previously existed.
No clinical trials are yet available to provide the necessary statistics on the effectiveness of cannabinoid use in ASD. Nor have any studies been conducted on prolonged medium and long term use of CBD or on potential unwanted consequences. However, for the moment CBD has shown to be safe and very untoxic. Indeed, no maximum dose has yet been identified.
We know, then, that both of these cannabinoids can be effective in cases of ASD. I think we now have to determine the most effective treatments, in terms of the ratio or proportion of THC to CBD which should be used.
Patients must not display any form of psychoactive effect from THC. Initially, CBD should be used. Only subsequently should we assess the need to add differing proportions of THC, until an improvement is achieved in different areas, depending in all cases on the patient’s evolution. Evidently, it is essential to assess the effectiveness of treatment and be vigilant for the possible appearance of any side effects.
Each case must be appraised on its own merits; no two patients are the same. It is also extremely important that clinical trials be conducted, to allow us to work with scientifically proven data. Although there is plenty of information available on cannabinoids, it is mostly based on preclinical data, essentially from animal experiments.Autism can be described as a disorder of neurodevelopment, causing alterations in social interaction and with the subject's surroundings. It also causes problems with verbal and non-verbal communication, and sometimes very restricted and usually repetitive behaviour. Parents usually start to become aware of these features during the first two years of life. However, this may
CBD oil and asperger syndrome
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- Research overview
- The studies
- Patient perspectives
- What the experts say
- Bottom line
Often regarded as a high-functioning form of autism, Asperger syndrome is part of the autism spectrum disorder (ASD) group. Typical symptoms of Asperger syndrome include delayed language development and social anxiety or disconnection.
Researchers have uncovered that a significant percentage of children with Asperger syndrome have been successfully treated with CBD-rich oil. Photo by: Gina Coleman/Weedmaps
Prescription medications for ASD, most notably risperidone, often come with serious side effects that affect the body, mind, and behavior, sometimes even precipitating violent outbursts. Thus, there is a growing need in the ASD community for a functional treatment option without such adverse effects.
Full-spectrum cannabis oil, derived from cannabidiol (CBD)-rich cultivars, utilizing the cannabinoid-rich flowers to maintain beneficial terpenes during the extraction process is showing some promise as a viable treatment option for patients with Asperger syndrome and their caregivers.
Whole-plant CBD oil has demonstrated potential for treating numerous incurable conditions. Among them are epilepsy, cancer, and Parkinson’s disease. Some studies have indicated that CBD oil may also serve as a treatment for ASD, including Asperger syndrome.
One study published in 2013 in the Journal of Autism and Developmental Disorders documented that children with autistic disorders have an increased number of cannabinoid receptors on their circulating white blood cells, suggesting an imbalance in their endocannabinoid systems (ECSs). Measuring endocannabinoid levels has been difficult because these compounds are made on-demand when needed and then broken down as soon as they are used.
Another study, by researchers from Stanford University in California and published in Molecular Autism in 2018, documented that children with autism have lower levels of anandamide compared with children not diagnosed with autism. Anandamide is one of the brain’s endocannabinoids, and it works to balance the neurotransmitter messages that are sent between cells. Without this compound, cells send inappropriate or overwhelming messages. This is the basis of treating autism with cannabis, as both of these studies demonstrate an endocannabinoid deficiency in children with ASD.
Studies indicate that CBD-rich cannabis oil may serve as a legitimate treatment for autism spectrum disorder, including Asperger syndrome. Photo by: Gina Coleman/Weedmaps
Further, a 2018 Israeli study examined the effects of oral CBD and THC on 60 children with autism. Researchers reported strong improvement in behavioral outbreaks in 61% of the children following treatment. However, fewer than half of the children experienced notable improvements in communication and anxiety. In either case, the sample size was limited, only one variety of cannabis was tested, and the results may not offer definitive answers. The scientists were nonetheless encouraged by the study and are now conducting a clinical trial with 120 children.
Beyond clinical trials, researchers have uncovered other evidence that a significant percentage of children with Asperger syndrome and other ASD diagnoses have been successfully treated with CBD-rich cannabis oil. Survey results published in 2019 in Remedy Review revealed that more than 40% of parents of children with ASD have tried some type of CBD treatment.
The most popular methods of administering CBD oil were via water (43%) and by inserting drops directly into the mouth (32%). The most common patient benefits reported by those surveyed were improved mood (56%), less anxiety (53%), and stress relief (45%). Finally, the parents whose children used CBD were nearly 55% more likely to rate the treatments as moderately or extremely effective compared to those using prescription medications.
For parents who feel they have exhausted all treatment options without success, a positive outcome with cannabis oil can seem remarkable. Rachel Anderson, whose son has a rare form of epilepsy and ASD, told Healthline in 2019, “we had tried six or seven pharmaceutical drugs. None of them worked, or if they did, they had serious side effects that made life miserable for all of us.”
Anderson claims the CBD oil has reduced her son’s seizures while addressing his ASD symptoms. She said, “My son is horribly anxious, but when we give him his CBD, he’s cool as a cucumber.”
What the experts say
Many expert opinions appear to align with the stories that parents are conveying. Dr. Bernard Rimland, who died in 2006, was the director of the Autism Research Institute in San Diego and wrote extensively about the potential of medical marijuana as a treatment for autism and associated disorders as editor of Autism Research Review International.
There is abundant anecdotal evidence to indicate that CBD-rich cannabis oil is an effective treatment option for Asperger syndrome and other forms of autism. Photo by: Gina Coleman/Weedmaps
Today, Rimland’s ideas are making progress. Other medical practitioners at the Autism Research Institute agreed with Rimland, and cannabis is listed as a treatment for ASD on the institute’s website. Indeed, the notion of using CBD oil and other cannabis treatments for Asperger syndrome is growing in the autism community. In 2018, Autism Speaks, a research and advocacy organization for autism spectrum disorders, hosted the first scientific conference on ASD and cannabis. Held in New York, the conference addressed the need for more research into the effects of cannabis on ASD.
“As more states legalize cannabis, we know that a growing number of families affected by autism are considering these products to relieve severe behavioral symptoms, seizures and other challenging autism-related conditions,” said Thomas Frazier, Ph.D., chief science officer for Autism Speaks. “But while anecdotal reports of benefit are common, we lack sufficient scientific evidence on effectiveness and risks.”
There is abundant anecdotal evidence to indicate that CBD-rich cannabis oil is an effective treatment option for Asperger syndrome and other forms of autism, but more in-depth studies with large sample sizes are needed to establish scientific proof.CBD oil and asperger syndrome Copy article link to clipboard. Link copied to clipboard. Contents Research overview The studies Patient perspectives What the experts ]]>