Autism and Cannabis at a Glance
- Autism is a collection of disorders that impact brain development, characterized by communication difficulties, social interaction problems, and repetitive and sometimes injurious behaviors
- Autism is caused by a combination of genetic mutations and environmental factors, such as advanced parental age and pregnancy problems
- Autism management focuses on therapies over drugs, including behavioral modification and social-skills coaching
- There are no clinical studies on cannabis and autism, but there is a growing body of positive anecdotal evidence from doctors and parents
- Lack of scientific data keeps doctors from endorsing cannabis in treating autism, but some promising ancillary research exists
- The many active compounds in cannabis may make proper dosing for children difficult to pinpoint, creating controversy in the medical community over its use
The Dilemma with Cannabis Treatment for Autism
It’s a chicken-and-egg thing: Doctors won’t prescribe cannabis to treat autism in children because no data exists to support such a course of treatment.
But the research doesn’t exist because of medical establishment fears about testing cannabis—with its many active compounds seen as potentially uncontrollable variables—on children.
In the absence of empirical data, however, is a growing body of anecdotal evidence that cannabis is making children with autism happier and healthier. And some doctors are listening.
“Anecdotes should not be dismissed,” said Dr. Daniele Piomelli, one of the world’s top neuroscientists and endocannabinoid researchers. The University of California-Irvine faculty member won’t consider prescribing cannabis at this time, but is aware of the growing clamor for it. “An anecdote is a pointer. It’s something that suggests something needs to be either proven or disproven.”
One researcher attempting to do just that is Dr. Giovanni Martinez, a clinical psychologist in Puerto Rico. His alternative therapy bona fides include his creation of SURF4DEM, a foundation that introduces children and families affected by autism to the therapeutic benefits of surfing.
Martinez is researching the therapeutic possibilities of treating children who have autism with CBD oil, and reports positive results. He recounted one particular case in which a child he treated spoke his first words after receiving a twice-daily spray of hemp oil. After three weeks, the child went from being non-verbal to developing significant language skills.
Moreover, Martinez reported that “initially the child would become so frustrated with his inability to communicate, he would would act out and injure himself. But, now that he can express himself, he laughs and enjoys life.” He added:
“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.”
Another success story comes from Mieko Hester-Perez, founder of the Unconventional Foundation for Autism, advisory board member to Cannabis Science. Coming from a conservative family with deep roots in law enforcement, she's an unlikely cannabis advocate, But she is also the mother of Joey, the boy for which Aaron Justis of Buds and Roses Collective and master cultivator Kyle Kushman developed Joey’s Strain.
Hester-Perez’s conversion to cannabis came when Joey, who has autism, was later diagnosed with Duchenne’s muscular dystrophy, a rare and aggressively degenerative muscular disorder. He was given six months to live, and in that time, would need to take a cocktail of FDA-approved medications with a severe degree of documented toxicity. At the time, he was already taking up to 13 different meds each day.
After researching less impactful, life-extending alternatives, Hester-Perez came across cannabis. Curious, she experimented with giving her son cannabis-infused edibles. Soon after, Joey began making eye contact—always a struggle for children with autism—on a more consistent basis. The edibles seemed to stimulate his appetite and he put on weight. Six years after that six-months-terminal diagnosis, Joey is happy, sociable and thriving.
Despite the results, some professionals in the medical and scientific communities criticized Hester-Perez for treating a child with cannabis, Her response:
“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?”
What is Autism?
Autism, or Autism Spectrum Disorder, refers to a collection of complex disorders that affect brain development. As a “spectrum,” ASD affects individuals in varying degrees, but generally a person with autism will suffer from three core symptoms:
- Communication difficulties
- Difficulties in social interaction
- Repetitive—sometimes self-injurious—behaviors
While some ASD children may be characterized as having an intellectual disability, some—often characterized as “high-functioning”—excel in music, math, and art. Symptoms may also improve as they get older. However, other ASD children are unable to speak and may engage in self-harming behaviors.
The Center for Disease Control and Prevention (CDC) estimates that 1.5 percent—or 1 in 68—of children in the U.S. have been diagnosed as being on the autism spectrum. The number of children diagnosed as being on the spectrum has increased tenfold over 40 years, with boys four to five times more likely to be diagnosed than girls.
What Causes Autism?
Until recent years, the answer was, “We don’t know.” Now we know that while there is no single cause, research tells us that autism can be traced to early brain development.
Within just the last few years, researchers have identified a number of mutations, or rare gene changes, a few of which may act as a catalyst for autism. In other cases, autism may be caused by a combination of environmental factors and a genetic predisposition, which affect early brain development.
The most obvious signs of autism surface between ages 2 and 3, so groups like the Organization for Autism Research have been funding research efforts to help detect autism at earlier ages—as early diagnoses may improve the effect of treatment options.
Other risk factors may include:
- Age of a parent (or parents) at time of conception
- Maternal illness during pregnancy
- Difficulties during pregnancy or birth—for example, oxygen deprivation to a baby’s brain
Independently, none of these factors causes autism; however, in conjunction with genetic factors, the risk increases. There is encouraging evidence that a woman may decrease the chances of autism in her child if she follows a diet that includes folic-rich foods and prenatal vitamins before and after conception.
What are Current Treatments for Autism?
Every child and his or her autism is unique, so what works for one child may have adverse effects in another.
The least controversial treatments are behavioral and may 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 Lovaas Model based on Applied Behavior Analysis (ABA)
- The Early Start Denver Model
Other studied and validated behavioral therapies that may be effective include:
As children grow older, other methods such as extensive structured and therapeutic activities, social skill development, daily living, motor skills development, and communication coaching can be valuable.
There are an astonishingly few approved medical treatments for autism. In fact, there are currently just two drugs approved by the FDA to treat irritability associated with autism, yet no drug has been approved to treat autism’s three core characteristics—communication difficulties, social challenges, and repetitive behaviors.
The two approved medications are:
- Risperidone (brand name Risperdal)
- Aripiprazole (brand name Abilify)
While these two drugs can provide relief by reducing irritability, self-injuring behaviors, and aggressive outbursts, there can be significant side effects, including diabetes, significant weight gain, gynecomastia (development of male breasts), movement disorders, and heart problems.
Numerous other medications are “experimental” or “off-label.” “Experimental” drugs can carry significant unknown risks, while “off-label” drugs have been approved for conditions that appear related to autism such as Attention Deficit Hyperactivity Disorder, depression, or sleep disorders.
Some of these drugs include:
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Stimulant medications like Adderall or Ritalin
- Naltrexone, an FDA-approved medication to treat alcohol and opioid addictions; it has shown success in some patients by alleviating disabling repetitive and self-injurious behaviors
It’s important to note that there have been no significant clinical trials to demonstrate risk or efficacy of these drugs in children with autism. Moreover, predicting which drug (and what dosage) may be effective has proven to be problematic.
Can Cannabis Treat Autism?
Increasingly, parents of children with severe autism, frustrated with the lack of options, have turned to cannabis. Many have heard anecdotal reports of success; others have read of promising results with epileptic children. However, clinical research remains nonexistent.
While you can now find 562 clinical studies (studies outside the lab on humans) involving cannabis listed on ClinicalTrials.gov—none involve epilepsy or autism.
However, that doesn’t mean there is no promising research:
- A 2013 study conducted by Dr. Dario Siniscalco found indications that certain compounds—namely the CB2 receptor—found in cannabis may be helpful in managing autism.
- 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.”
- Dr. Daniele Piomelli and Dr. Olivier Manzoni discovered that certain chemicals found in cannabis may help behavioral issues in children with autism or Fragile X syndrome.
Piomelli has presided over some groundbreaking discoveries, including the potential of cannabinoids—specifically one endocannabinoid called anandamide. He demonstrated it could be used to treat autism by regulating social reward.
According to Piomelli, his team discovered endocannabinoids appear not only to be important in regulating normal social behavior, but also to be possibly involved in the dysfunctional behavior that accompanies at least 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.
Is Cannabis Therapy Worth the Risk?
Because scientists are driven by data, 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.
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:
“[P]harmacology 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 actually 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.”
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 its infancy. 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.
