It seems every convenience store these days has an endcap or cabinet full of CBD products for sale. The vast proliferation of such products is partly a sign of recently loosened laws regarding marijuana’s use in some states. And it’s partially about Americans’ increased willingness to try alternative treatments for certain chronic or hard to manage conditions.
One of the conditions that CBD oil has been suggested as potentially helpful for is autism, now called autism spectrum disorder or ASD. But can CBD actually make a difference with such a complex condition as ASD, and is it safe?
What Is Autism?
Autism spectrum disorder is a complex developmental disability. It usually shows up within the first three years of life and involves impairments in social interaction. People with autism have difficulty interacting with others socially and being aware of other people’s feelings. People with ASD may not be as quick or able to observe and respond to ot hers’ nonverbal communication, and some may misinterpret verbal communications. People with autism also sometimes exhibit unusual eating or sleeping behaviors or have a tendency towards self-harming activities, such as banging their heads.
Not everyone with ASD exhibits the same range or severity of symptoms, hence the classification of autism as a spectrum of disorders with a wide range of presentations. Some people with ASD need a lot of assistance to conduct activities of daily living, while others need very little help.
Since autism was added to the Diagnostic and Statistical Manual of Mental Disorders in 1980, rates of diagnosis have increased. The Centers for Disease Control and Prevention reports that today, 1 in 54 children has been diagnosed with ASD. Cases occur across all racial, ethnic and socioeconomic groups.
How Is Autism Treated?
Early intervention can make a big difference in how well a person with ASD will be able to care for themselves later in life. Annette Nunez, a licensed psychotherapist and founder and director of Breakthrough Interventions, LLC, based in Denver, has worked with children with ASD and other related disorders for over 22 years. She says there are several therapeutic interventions “that have proven to be effective.”
Most of them use innovative ways of reaching the autistic child through educational or psychotherapeutic means.
Dr. Harrison Weed, an internal medicine specialist at the Ohio State University Wexner Medical Center in Columbus, says that educational programs designed for autistic children are especially important. The core features of successful educational programs for people with autism include:
— A high staff to student ratio.
— Individual programming for each child.
— Teachers with special expertise in working with children with autism.
— At least 25 hours per week of services.
— An adaptable curriculum that “emphasizes attention, imitation, communication, play, social interaction, regulation and self-advocacy,” Weed says. Those curricula should be adjustable based on how the child is progressing.
— Stability and predictability to the routine.
In addition to educational programs and psychological support, some children have also benefited from following a special diet, Nunes says. Specifically, diets that are free of gluten, a type of protein found in cereal grains, and diets that eliminate casein, a diary protein, have been helpful for some people with autism.
In some cases, pharmacological intervention may be warranted. Weed says that for some children with autism, medication may be indicated if there’s an accompanying psychiatric or neurodevelopmental condition that can be treated with such. It may also come into play if “behavioral symptoms interfere with learning, socialization, health, safety, quality of life or overall functions.”
Weed notes that medication decisions need to be made on “a case-by-case basis,” and are usually reserved for situations where other interventions have been exhausted. Only two medications — risperidone and aripiprazole — have been approved by the FDA for use in children with autism. Fluoxetine (Prozac) is also sometimes used and “has had variable benefit for controlling repetitive behaviors in children with autism,” he says.
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What Is CBD Oil?
CBD or cannabidiol oil is “an extract of the plant Cannabis sativa,” Weed says. “Cannabis sativa can have a high content of the psychoactive chemical THC (tetrahydrocannabinol), in which case it’s referred to as marijuana.”
When the plant contains low concentrations of THC, it’s referred to as hemp. “Extracts that contain mostly CBD and only very small amounts of THC are referred to as CBD oil,” he explains. THC is the chemical that produces the euphoria or “high” associated with marijuana. CBD products have very low levels of this chemical and thus are less liable to induce those sensations. The 2018 Farm Bill stipulated that products containing cannabis or cannabis-derived compounds must contain no more than 0.3% THC.
CBD has medicinal properties, Weed explains. “It’s available as a prescription medication called Epidiolex in the U.S.” That medication is the only FDA-approved medical use of CBD and it’s used to “control some specific types of childhood seizures,” such as those that occur in Dravet Syndrome and Lennox-Gastaut Syndrome.
“There are no other FDA-approved indications for CBD because there’s no reliable scientific evidence supporting any other medicinal use of CBD,” Weed says, but CBD products are widely available without a prescription.
CBD oil has become popular over the last several years as a way of easing symptoms associated with a variety of conditions. “CBD can be sedating and is commonly used to treat insomnia and anxiety,” Weed says. But these claims are backed up by very limited science. “It’s a fad because of recent state-level decriminalization of marijuana/hemp products and the internet availability of product,” Weed explains. Also, because it’s viewed as a “natural” substance, many people associate that with it being harmless, which may not be the case.
“For chronic, difficult-to-live-with conditions that have no good treatments, there is always a yearning for some cure or treatment,” Weed says, so some people are turning to CBD oil to help.
Can CBD Oil Be Used to Treat Autism?
With regard to autism specifically, Weed notes that “autism spectrum disorder is a complex illness/disability. Therefore, evaluation and treatment are complex. It does not lend itself to simple answers. Families dealing with it are often desperate and therefore willing to try unproven, even dangerous treatments.”
CBD oil can seem attractive to some parents who are struggling with their child’s diagnosis. “There are many testimonials on the internet in which individuals with autism or their parents talk about the benefits of CBD oil,” Nunez says. “They talk about how it calms them, makes them less anxious and can stop seizures.”
There have been a few studies completed in Israel that showed some benefit of CBD, but they didn’t have a control group to compare the results to. Similarly, anecdotal observances of a positive effect are uncontrolled. In both cases, the positive effects observed could be the result of something other than the CBD itself.
“It’s hard to know if the changes they saw in those studies are related to the CBD use or if they would have happened anyway. There’s a natural tendency in autism for behaviors to improve with age,” says Dr. Katharine E. Zuckerman, associate professor of pediatrics at Oregon Health & Science University in Portland and a member of the American Academy of Pediatrics Council on Children with Disabilities.
In addition, “often, when you give children a treatment or a medication, there’s a pretty strong placebo effect, especially when all outcomes are parent-reported,” she explains.
All that said, Zuckerman adds, “I don’t want to give you the impression that it’s not effective because it’s quite possible that it is. It’s just that we don’t know. That’s why the American Academy of Pediatrics doesn’t recommend it — because we have no cause to recommend it, per se.”
Some of these questions could be cleared up with some large, controlled clinical trials. But there’s another issue when it comes to CBD: legality.
Marijuana is still classified as a Schedule 1 drug at the federal level. The U.S. Drug Enforcement Administration classifies drugs, with Schedule 1 being the most restricted class. Drugs in this class have “no currently accepted medical use and a high potential for abuse,” according to the agency. Other Schedule 1 drugs are heroin, LSD and ecstasy. Though some states have liberalized laws surrounding marijuana, hemp and CBD products, there could still be legal ramifications to studying or using these products.
That makes securing the funding for research — which typically comes from federal coffers — much more difficult. “It’s a really big problem,” Zukerman says. “Most research into autism is federally funded through the National Institutes of Health, and as long as marijuana is a Schedule 1 drug, that creates a huge barrier for researchers to do large-scale studies on this.”
But there is some hope that more conclusive research could be forthcoming. “Recently, the Center for Medicinal Cannabis Research, based out of UC San Diego, granted funding to conduct a study which looks at the effects of CBD on symptoms of severe autism,” Nunez says.
Should You Try It?
So, with all that said, is it worth it to try using CBD oil to manage your child’s autism? Zuckerman says you should speak with your child’s pediatrician. “Talk to your doctor about it. We want to know what you’re trying. We won’t get mad at you if you want to try something a little out of the box. But we want to make sure that whatever you’re using is safe.”
She adds that “CBD is a drug. It’s a medication. It has pharmacological properties. We have to consider that in the context of whatever else the child is taking,” and your doctor can advise you on whether it’s safe to try adding CBD. “It’s important for parents to think about CBD as a medication. It may have benefits, and it has risks, too. The problem is that right now we don’t know whether the risks outweigh the benefits.”
Adverse effects that have been associated with CBD products include:
— Sedation and fatigue.
— Dry mouth.
— Negative interactions with other medications.
Nunez urges parents of children with ASD who are considering using an alternative therapy like CBD “to educate themselves about CBD products and know the difference between CBD oils and CBD with THC.”
As Zuckerman notes, there have been some studies investigating how marijuana impacts adolescents. These studies found that high levels of THC are “not good for child brain development overall, especially in terms of academic and social outcomes. But how that applies to younger children who have a whole different suite of behavioral challenges is really unknown.”
Weed also cautions that you need to consider carefully where the product is coming from. “Unless you purchase CBD through a state-regulated program, such as Ohio’s Medical Marijuana program, the CBD supplement you use is not regulated for purity or safety. You don’t know how much CBD you’re getting, if any, and you don’t know if the supplement contains other drugs or contaminants that could be dangerous in the short term or the long term.”
Bottom line, Weed says that while you could take CBD oil or give it to your child to address autism, “it would likely be best for you and for others if this were done in the context of a clinical trial. The only way to advance knowledge and treatment is for people to participate in well-controlled clinical trials.” And be sure to check with your doctor before starting any new treatment or therapy, even if it’s an over-the-counter item you can find at your corner gas station.
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