A study of children with autism spectrum disorders in Israel reported significant improvements in their social communication abilities after six months of treatment with cannabidiol-rich cannabis oil. Additionally, parents reported a reduction in restrictive and repetitive behaviors of children. Children’s cognitive scores were not changed. The study was published in Translational Psychiatry.
Autism spectrum disorders (ASD) symptoms include persistent deficits in social communication and restricted and repetitive patterns of behavior or interests. At the moment, there are no approved medications for treating the core symptoms of these disorders. Patients suffering from ASD are often prescribed medications to treat symptoms related to ASD, but not ASD itself. Due to this, research into novel ways to treat autism spectrum disorders is of great significance for science.
Previous studies have found that endocannabinoids (lipid neuromodulators that regulate excitatory and inhibitory synaptic transmission through the activation of cannabinoid receptors) also impact behavior, including cognitive functions, social motivation and emotional regulations. Such substances include anandamide (AEA) and 2-arachidonoyl glycerol (2-AG). The former was found to improve social functioning of experimental mice with impairments similar to ASD and also of female prairie voles.
Studies on children with ASD, in countries that legalized the use of cannabis for medicinal purposes, reported that children responded well to treatment with cannabis rich in cannabidiol (CBD). Reports indicated improvements in social communication and reductions in disruptive behaviors, self-injuries, tantrums, restlessness and agitation. Researchers, on the other hand, had concerns that tetrahydrocannabinol (THC), another component of cannabis, might induce psychosis. This is the reason that CBD-rich cannabis was selected for research in children.
“My interest in medical cannabis started about 5-6 years ago, when parents to children with ASD contacted me for my opinion/advice and I found myself embarrassed because I had no knowledge in the field and on the other hand I saw children who received medical cannabis oil and were better,” explained study author Orit E. Stolar, a pediatrician specializing in pediatric neurology and child development.
“There was one specific patient who, after visiting my clinic, I realized that I had to delve deeper and try to understand and learn because there is probably something in the cannabis oil that works. The same boy for years would destroy my clinic and during that visit he sat on the chair. The mother shared that she started giving him cannabis oil.”
Aiming to expand existing knowledge of ASD treatment using CBD-rich cannabis, Stolar and her colleagues conducted a study on 82 children who fulfilled diagnostic criteria for autism spectrum disorder and whose parents reported disruptive behavioral problems over the preceding six months. The average age of the children in the study was 9 years and 65 of the children were boys. The study was “open label,” meaning that both participants and researchers knew what substance they were taking.
Before and after the six-month treatment period, participants completed a range of psychological and psychiatric assessments that included an assessment of the severity of autistic symptoms (Autism Diagnostic Observation Schedule), cognitive assessments (Wechsler Intelligence Scale), assessments of adaptive behavior (Vineland Adaptive Behavior Scale) and of the child’s social skills (Social Responsiveness Scale).
“Parents received a supply of medicinal cannabis whole-plant extract infused in medium-chain triglyceride (MCT) oil with a CBD:THC ratio of 20:1… The exact same product was used throughout the treatment period. Parents were instructed to start with one drop daily (each drop contains: 0.3 mg THC and 5.7 mg CBD) and increase the dosage gradually until they perceived improvements in their child’s behavior such as decreased irritability, aggressiveness, hyperactivity, and/or sleep disturbances,” the researchers described in their study.
The amount and timing of doses was tailored for each child individually, but the final dose did not exceed 10mg/kg/day. Parents were interviewed by phone every two weeks and asked about compliance with the treatment, behavior, symptoms and side effects.
Results showed significant improvements in a number of assessments used in the study. These were mostly driven by improvements in social communication skills. The effects were greater in children who initially had more pronounced autism symptoms. Results also showed improvements related to restricted and repetitive behaviors as reported by parents through the Social Responsiveness Scale.
“I would be happy if the doctors who treat children on the autistic spectrum would consider giving cannabis oil the same way they consider giving treatment with risperidone or aripiprazole,” Stolar told PsyPost. “The cannabis oil is really not a panacea and does not solve all problems, but for some children there is no doubt that it helps them behave and function better on a daily basis.”
“Our art as therapists is to study and identify those children who can benefit from this therapy. Parents of children on the spectrum, I would be happy to give them hope that there is a treatment that can make day-to-day life easier with fewer side effects. On the other hand, it should be remembered that the research shows that the treatment is only effective for some children.”
The study shed light on a possible new approach to treating autism spectrum disorders in children. However, there are also limitations to be taken into account. Notably, this was an open label study, meaning that both participants and researchers knew what substance they were taking and what the treatment was about. This could have influenced the assessments, as they were done by parents and researchers. Future studies that include a placebo control group and a double-blind design would be needed to verify the obtained results.
The study, “Children and adolescents with ASD treated with CBD-rich cannabis exhibit significant improvements particularly in social symptoms: an open label study”, was authored by Micha Hacohen, Orit E. Stolar, Matitiahu Berkovitch, Odelia Elkana, Elkana Kohn, Ariela Hazan, Eli Heyman, Yael Sobol, Danel Waissengreen, Eynat Gal, and Ilan Dinstein.
