Authored by Alex Lambrianidis, Biological Sciences ‘24
What first comes to mind when you hear the word, “cannabis”? Maybe you think of its sister term, “marijuana,” and are familiar with its potent smell. Perhaps you assess the legality of the drug, as lively debates are often launched between family members, friends, and politicians alike. You may have heard of anecdotal evidence – its ability to ease the pain associated with multiple sclerosis, Parkinson’s, glaucoma, and others [1]. In recent years, however, researchers have been entertaining the idea of expanding its medicinal use to treat one prominent developmental disorder: autism [2].
Autism Spectrum Disorder (ASD) defines a wide range of neurodevelopmental disorders characterized by cognitive deficits in communication and social interaction. Individuals with ASD also display patterns of repetitive behaviors and intellectual disabilities [3]. Children with ASD may also exhibit comorbidities such as hyperactivity, sleep disorders, anxiety, and self-injury [4]. These more aggressive symptoms are of great concern to families who are willing to seek solutions through unproven methods.
The increasing prevalence of ASD among today’s youth is a concerning trend in the last decade. In 2018, the incidence of ASD was identified in 1 out of 44 children. Compared to the 2010 numbers (1 in 68), we see a 53% jump in occurrence, making ASD one of the fastest growing developmental disorders to date [5]. Despite this incidence, standard behavioral and medicinal practices have been unsuccessful in treating the core symptoms of ASD. Currently, there are only two drugs approved by the Food and Drug Administration (FDA) to help alleviate symptoms of irritability and aggression. While many respond positively to these treatments, nearly 40% of individuals reported little improvement in cognitive functioning and behavior [6]. To address this gap, researchers have ventured outside the box to explore other therapeutic alternatives.
Cannabis, derived from Cannabis sativa, has been studied for its medicinal purposes in treating diseases of both the body and mind since the nineteenth century. Today, however, cannabis is categorized as a schedule one drug, and remains illegal under federal law. While medicinal usage has been decriminalized in over 34 states, the lack of sound evidence in favor of its efficacy and safety has discouraged physicians from recommending the treatment [2].
The cannabis plant consists of two active chemical compounds, known as cannabinoids. Δ9-tetrahydrocannabinol (THC) targets the body’s central nervous system to affect appetite and anxiety, while producing the notable intoxicating “high” [2]. Cannabidiol (CBD), on the other hand, has been shown to relieve pain, treat sleep disorders, and improve cognitive processes, such as attention and memory [2,4]. As a result, CBD has been the primary source of interest as a treatment for individuals with ASD. Its potential to target the more extreme comorbidities, as well as addressing the root issue of cognitive functioning, has garnered the optimism of researchers in the field.
Two key studies in Israel have started to shed light on the potential for cannabis as a treatment for ASD in children [2]. In one study, 53 children were administered oral cannabinoids in a 20:1 ratio of CBD to THC. Over a period of 66 days, researchers conducted biweekly interviews with parents to assess the effects associated with self-injury, hyperactivity, sleep, and anxiety. According to the researchers, 67.8% reported improvements in self-injury and rage attacks, 68.4% improved in hyperactivity, 71.4% improved sleep quality, and 47.1% improved anxiety [7]. In a similar study, 60 children were administered cannabinoids over two to four weeks. Overall, 61% reported “much improved” behavioral tendencies, and 47% reported improvements in communication [8]. While these findings are indeed promising, one important question remains: Is this statistically different from that of the conventional treatments for ASD?
In short, the unfortunate answer is no. However, by no means does this indicate there is no future for this treatment. In many of the previously conducted studies, the research has been severely constrained in the scope of evidence collected. Small sample sizes and a lack of control groups have precluded the expansion of supportive findings [2]. To continue exploring this hypothesis, researchers require large-scale, double-blind clinical trials to further investigate cannabis as a viable treatment option.
With such a large-scale methodology needed, an important question of ethics arises. The two studies that were previously discussed were not met without adverse effects. While many reported improvements in comorbidities, a select few reported a worsening of symptoms [2]. Most notably, 23.5% of individuals were reported to have worsened anxiety. The most frequent concerns included somnolence and decreased appetites [7]. In one rare case, an individual was treated for a psychotic episode after receiving an increased dosage [8]. Instances such as these reflect the severity of the issue and demand the highest scrutiny to proceed any further.
Given all the information researchers know about cannabis, there is still a multitude to uncover. The same can be said for ASD – perhaps even to a greater extent. The union of these two intricate fields thus poses a significant challenge to overcome. Despite the optimism, researchers should proceed with the utmost caution and sensitivity. Ultimately, there remains much to know about cannabis and its potential to help treat ASD. In the meantime, researchers and families alike are advised to keep an open-mind, while staying updated with the latest developments in the science behind it all.
Works Cited
Grinspoon, P. (2020, April 10). Medical marijuana. Harvard Health. https://www.health.harvard.edu/blog/medical-marijuana-2018011513085
Agarwal, R., Burke, S. L., & Maddux, M. (2019, October 29). Current state of evidence of cannabis utilization for treatment of autism spectrum disorders. BMC Psychiatry, 19(1), 328. https://doi.org/10.1186/s12888-019-2259-4
Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2018, August 29). Cannabidiol as a suggested candidate for treatment of autism spectrum disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 90–96. https://doi.org/10.1016/j.pnpbp.2018.08.030
Silva Junior, E. A. da, Medeiros, W. M. B., Torro, N., Sousa, J. M. M. de, Almeida, I. B. C. M. de, Costa, F. B. da, Pontes, K. M., Nunes, E. L. G., Rosa, M. D. da, & Albuquerque, K. L. G. D. de. (2021, January 13). Cannabis and cannabinoid use in autism spectrum disorder: A systematic review. Trends in Psychiatry and Psychotherapy, 44. https://doi.org/10.47626/2237-6089-2020-0149
CDC. (2022, March 2). Data and Statistics on Autism Spectrum Disorder. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/data.html
Alsayouf, H. A., Talo, H., Biddappa, M. L., & Reyes, E. D. L. (2021, April 22). Risperidone or Aripiprazole Can Resolve Autism Core Signs and Symptoms in Young Children: Case Study. Children, 8(5). https://doi.org/10.3390/children8050318
Barchel, D., Stolar, O., De-Haan, T., Ziv-Baran, T., Saban, N., Fuchs, D. O., Koren, G., & Berkovitch, M. (2019, January 9). Oral Cannabidiol Use in Children With Autism Spectrum Disorder to Treat Related Symptoms and Co-morbidities. Frontiers in Pharmacology, 9. https://www.frontiersin.org/articles/10.3389/fphar.2018.01521
Aran, A., Cassuto, H., Lubotzky, A., Wattad, N., & Hazan, E. (2018, October 31). Cannabidiol-Rich Cannabis in Children with Autism Spectrum Disorder and Severe Behavioral Problems—A Retrospective Feasibility Study. Journal of Autism and Developmental Disorders, 49(3), 1284–1288. https://doi.org/10.1007/s10803-018-3808-2