“Hope for the autism community”
“My son began to speak after 2 days”
If you’re a parent that has a child with autism, you might wonder if these anecdotal reports about CBD Oil are actually true. It’s hard to ignore the growing popularity of our society using CBD to treat many different conditions and symptoms. Sources like Forbes project CBD products to be a $2.2 billion dollar industry over the next 2 years.
CBD is recommended as a treatment for conditions such as seizures, depression and anxiety, and symptoms such as sleeplessness, inflammation, acne and pain. It seems to be something that everyone could benefit from using; its effects can be so widespread. But can CBD oil really help children and adults with autism?
Cannabis plants produce thousands of compounds but the most recognized belong to a class called cannabinoids. There are several cannabinoids but the two that are most well-known among consumers are THC (tetrahydrocannabinol) and CBD (cannabidiol).
Derived from an extraction process from the flowers and buds of cannabis plants, either marijuana or hemp, CBD does not produce intoxication as it is a non-psychoactive compound, unlike marijuana's "high" which is caused by the chemical tetrahydrocannabinol (THC).
If you are interested in or have been researching medicinal marijuana for those with autism, CBD oil could possibly be a better option. This is something you should discuss with your child’s doctor.
You may hear the term “hemp oil” when referring to CBD oil. Hemp is one of the varieties of cannabis plants that CBD is most commonly extracted from. Although in most cases CBD oil from hemp has no THC, it’s important to note that isn't always the case. So going forward, we recommend focusing on CBD oil for those with autism.
CBD oil can be taken orally in many forms - some sources break consumption into categories – ingestible, topical, and smokeable. CBD oil can be administered in a dropper as a tincture, be encapsulated into a pill, baked into a brownie, vaped or even smoked. CBD products include edibles like gummies, beverage drinks, soaps, and creams or a transdermal patch similar to a nicotine patch.
Besides the type of plant CBD is extracted from, you can also choose the type of CBD you want based on how it’s processed. Full spectrum, or "whole plant" CBD, has a variety of potentially beneficial cannabinoids plus plant terpenes and flavonoids found in the original plant. CBD isolate is when all the other cannabis compounds are removed and only the CBD is left. It is not "whole plant" based and contains only one part.
It's believed that using full-spectrum has more benefits than using CBD alone.
There are so many brands of CBD oil to choose from. There are also many "snake oils" on the market, so it's important to do your research. Find out the source of the CBD, where it's grown and how it's processed. You should check third-party testing results provided by CBD Oil companies.
If a company can't provide you with a third-party lab test or a certificate of authentication (CoA), then we would recommend finding another brand.
In December 2018, Congress passed the 2018 Farm Bill which, if it hasn't already, will be signed by the President.
What this means is that CBD processed from hemp, with a THC level less than 0.3%, will be legal in all 50 states. If CBD oil has more than 0.3% THC it is considered non-hemp and has no federal legal protection at all.
And even though CBD oil from hemp is now legal, there are still strict regulations, as well as government oversight as to who can grow hemp, where it can be grown and how it's cultivated and produced.
Click here for state by state regulations concerning cannabis products that do not fall under the protections of the 2018 Farm Bill.
Some states allow doctors to use their clinical discretion to prescribe CBD to their autistic patients. Some parents have sought out CBD separately to treat other symptoms such as pain or sleep issues, and have noted the secondary effects on the symptoms of autism. The therapeutic properties of cannabis, primarily of CBD, can help alleviate some of the negative behavioral effects of autism, such as anxiety and epileptic seizures.
Additionally, with CBD oil there are regulation issues around how much CBD vs THC are in the oil. Oral absorption is difficult to measure, and it is thought that less than 20% of the drug is absorbed when taken by mouth.
A recent study of CBD oil products found some productions had too little and others too much, and 1/5 CBD products contained THC, which can cause anxiety or make seizures worse.
As with any new treatment, it needs to be closely followed by doctors to watch for potential interactions with other meds, as well as resultant liver problems.
There is no recommended daily allowance (RDA) of CBD. Doctors may suggest a dosage to a patient, but don’t typically prescribe it due to legal issues. For doctors in training, the use of CBD oil and its benefits hasn’t been studied enough to be taught in pharmacology classes in medical school – there are no experts here.
CBD oil manufacturers often recommend a serving size on the label, but the amount of CBD is different in each product. The most common recommendation is to start small and increase as needed. Our chart will give you an idea of where to start with your child based on his or her weight.
Because every child is different, it will take time to find the best dose for your child.
We as humans all have an endocannabinoid system that receives signals from cannabinoid that enters the body. When you consume CBD it enters your bloodstream, brain and nervous system almost immediately.
The endocannabinoid system moves in the opposite direction when compared to neurotransmitters. It moves up to the neurons and attaches to the cannabinoid receptors of the neuron that will send a “message”. Once there, the cannabinoids control what happens the next time the neurons activate and can effectively change what happens to the body and mind.
Endocannabinoids can help regulate hunger, anxiety, neuronal excitability, protection and pain, among other things. With individuals with epilepsy, CBD oil can help suppress seizures. Those who look to cannabinoid medicine to help with autism believe that it can help bring order to the brain. It is well known that individuals with autism struggle with focus and attention, and cannabis can alter their spectrum of attention.
The effect of CBD oil begins at different rates for different people depending on dosage and product. Vaping/smoking can produce effects the quickest, sublingual tinctures may take 20-40 minutes, and edibles can take 1-2 hours to move through the digestive system. CBD taken topically in a cream or salve can also take an hour to get into the bloodstream, but their effects can last up to 6 hours.
We want to know how CBD oil impacts autism. Is CBD an effective treatment for autism? Is obtaining medical marijuana for autism a good investment of time and resources? And do the benefits outweigh the risks?
There are multiple facets to consider when answering these questions. The simple answer is that there isn’t a wealth of research done for pediatric patients with autism – there is practically NO study validating the idea that cannabis is an effective and available option for the treatment of autism yet.
Nevertheless, one can’t ignore the reports of this “miracle drug” that has so many proven success stories.
For an individual with autism, a developmental disability with no proven “treatment”, you’re open to many therapies and strategies that might alleviate symptoms. CBD itself has shown promising results as a treatment for a variety of conditions, many of which are otherwise not treatable.
The most well-known properties of CBD are neuroprotective, anticonvulsant, anti-inflammatory and analgesic. CBD also possesses therapeutic value to treat conditions like depression, anxiety, and dependence.
Some reports show a decline in aggressive behavior, a significant decrease in seizures, and improved speech. Some accounts include children who did not speak before treatment who achieved significant results in a short period of time after their first dose of CBD oil.
Back in 2015, the Harvard Review and Boston Children’s Hospital put together a baseline study of cannabis research to date, which stated that most research was animal-based and did not yet show generalized impact to human subjects.
The review concluded with the cautionary statement that cannabis treatments should be used as a last resort after all conventional therapies have failed. Indeed, a widespread reluctance exists within the pediatric community to study the effects of cannabis in children, due to the potential of harmful side effects.
There have been hundreds of studies on the effect of marijuana and different health impacts. Currently, there are two studies slated to study cannabis specific to autism – but they have not yet started. There is a risk to study children in general, and especially with a controlled substance like marijuana, which is known to damage the cells of a developing brain.
In many studies of CBD oil, there have been clinical trials done with adults, but they are not specific to children. Use of CBD oil for antipsychotic, antidepressant or sleep aid uses have been studied on animals but limited research has been to include humans.
Some published studies used case reports and retrospective accounts, but not true research with clinical trials and placebo groups. A recent retrospective study of individuals with ASD did report improvement in disruptive behavior, anxiety, and communications. Unfortunately, there were some (minimally reported) adverse effects such as sleep disturbance, irritability, and loss of appetite in participants.
A pediatric neurologist in Israel began research last year with 60 children on the autism spectrum and while still to be published, some preliminary results have been released. These qualifying study subjects had not responded to previous conventional drug therapies. 80% of participants who were treated for 7 months with 20:1 ratio of CBD to THC saw improvements. After the study, parents were asked about communication, behavior, and anxiety. 80% of parents noted a decrease in problem behavior, with 62% reporting significant improvement in behavior. Additionally, 50% noted an improvement in communication, 40% reported a decrease in anxiety (2/3 of the participants began the study with anxiety).
In 2017, there was a retrospective study conducted in Chile on 20 children who were given a CBD oil tincture orally for 3 months. The CBD to THC ratio was 1:1 – but the specific dosage wasn’t indicated. In looking at that study, one can note that this substance was not solely CBD, but equal parts CBD and THC.
The positive part of this study was that it was done with children with ASD – something that we don’t have a lot of research on. The outcome of the study was that caregivers reported improvement in at least one core symptom of autism - social communication, language, or repetitive behaviors. Additionally, sensory difficulties, food-based/texture tolerance, sleep disorders, and/or seizures improved as well.
Did you know that less than 2% of the general population has epilepsy, but up to 33% of people with autism also suffer from epilepsy? While scientists do not clearly understand the reasons behind the relationship, they suspect that the different brain development that occurs in autistic children is more likely to create circuits that cause epileptic seizures. Earlier this year, a U.S. Food and Drug Administration advisory panel unanimously recommended approval of the CBD medication Epidiolex to treat two rare forms of childhood epilepsy, Dravet Syndrome and Lennox-Gastaut Syndrome. These two conditions have early onset in childhood and present with seizures that are difficult to control. The syndromes have impacts that grossly affect the child’s development and overall quality of life. This news is huge for the medical and autism community; as this is the first time the FDA has approved a marijuana-derived substance.
Efforts to legalize cannabis continues –although there are significant concerns that it will become more available to adults and teens, and its dangerous effect on brain development. You probably see the movement in your own states and communities, depending on where you live. In the meantime, activist groups like MAMMA (Mothers Advocating Medical Marijuana for Autism) are working tirelessly to add autism as a qualifying condition for medical marijuana use in certain states where it is already legal.
Continued research involving CBD and autism is needed to continue to validate these incredible anecdotal reports. US-based studies are necessary to influence decision-makers in our country. Fortunately, there are more studies coming, which will be conducted in the United States.
Large grants and donations have been allocated for research out of University of California San Diego and Montefiore Medical Center in New York as well as New York University. There was a $4.7 million dollar gift for medical marijuana research specific to autism, the largest private gift for cannabis research in our country.
Safer production, consistent packaging, and streamlined recommendations are needed for medical use of CBD oil. PCP involvement in monitoring the use of CBD oil is crucial – especially to watch for interaction with other drugs, liver health, and symptom management. Patient education about all of these issues is necessary to create informed consumers to validate this new “miracle drug”.
We are at an exciting point as we watch cannabis products, especially CBD oil, become more mainstream in our pool of alternative therapies for autism.
Although with marijuana, there can be a risk to the developing brain and the fear of access for all teens/children, it’s not hard to see why legalization is so difficult. These same risks don’t seem to exist with CBD Oil.
There are so many positive impacts of CBD for conditions that aren’t easily remediated, many of which are the core symptoms of autism. But safety is still a concern.
It’s hard to ignore those accounts of children who have never spoken, of individuals whose behaviors were so difficult but untouched by conventional drug therapies. A parent will do anything to help their child but should know how the risks and benefits compare.
Molly Shaw Wilson MS OTR/L BCP is a board-certified pediatric occupational therapist with 16 years experience. She owns a private practice and provides service in homes, community and school settings, as well as her outpatient sensory clinic. Molly enjoys working with young children and their families, focusing on parent-child interactions and home routines. She is a regular contributor to a parenting blog about typical development. Her professional interests have stemmed from her certificate work in assistive technology, hippotherapy practice, and consultation to a nature-based program in New Hampshire. To find out more about Molly, please visit her website at www.trainingwheelsnh.com
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