Autism Spectrum Disorder and Cannabidiol : Have We Seen This Movie Before?
Carlos A. Salgado, and Daniel Castellanos,
Glob Pediatr Health. 2018; 5: 2333794X18815412
Received July 5, 2018. Received revised October 9, 2018. Accepted for publication October 23, 2018.
Recently, the use of marijuana and cannabidiol (CBD) in children with autism spectrum disorder (ASD) has received increasing attention in the media with articles sensationally titled “Marijuana may be a miracle treatment for children with autism.” An absence of empirical data appears to have resulted in a growing body of anecdotal evidence espousing the benefits of CBD for children with ASD. Some reports describe the effects as miraculous or “unbelievable.” Increasingly, parents of children with severe ASD, frustrated with the lack of options, have turned to CBD. Many have heard anecdotal reports of success; others have read of promising results with epileptic children. Parents who frequently felt they had exhausted all other options have turned to CBD as a “last resort.” An increasing number of parents are advocating for their children to be treated with CBD. Vocal parents have taken to the internet utilizing social media to distribute their message. However, clinical research remains nearly nonexistent.
History is laced with similar examples of parents and professionals attempting to help children with ASD. In 1998, Horvath and colleagues reported “dramatic improvement” in the behaviors of 3 children with ASD after intravenous administration of secretin, followed by renowned autism expert Bernard Rimland’s report on the behavioral, cognitive, and sensory improvements of a child who was administered secretin. On the basis of these first reports many parents of children with ASD pursued treatment with secretin, although secretin was not a proven, effective treatment and there was inadequate information about side effects. Since then, 16 randomized, placebo-controlled trials studying over 900 children have demonstrated a lack of evidence supporting that a single or multiple dose intravenous secretin is effective in improving the core symptoms of ASD (social and emotional reciprocity; restrictive, repetitive behaviors).
Currently, secretin is not to be recommended as an evidence-based treatment for individuals with ASD.
Another such example is hyperbaric oxygen therapy (HBOT). HBOT is a daily treatment where a patient enters a hyperbaric chamber and the atmospheric pressure is increased well above sea level. Several small, uncontrolled case reports and case series reported some improvements in symptom scores in children with ASD who were treated with HBOT. Only one randomized controlled trial (RCT) reported effectiveness of this treatment, although the study has been criticized due to several methodological problems and those results have yet to be replicated. In 2017, the US Food and Drug Administration (FDA) issued warnings of legal action against several companies marketing unproven and potentially dangerous products and treatments for autism; HBOT as well as chelation therapies and detoxifying clay baths are included in these warnings.
This commentary provides guidance to clinicians who care for children with ASD. We identify the current level of evidence for the safe and effective use of CBD with children diagnosed with ASD and provide guidance for clinicians who encounter this population of children and families. The increasing popularity of the use of CBD for children with ASD as well as the history of failed examples of unproven products suggests a need to provide perspective and guidance on this topic.
The use of CBD for clinical applications has gained increasing attention given its lack of psychoactive properties and potential benefits that have been noted in certain disease states, such as pediatric epilepsy and adult disorders. There is a paucity of literature supporting the clinical evidence for use of CBD in ASD. CBD and similar products remain a promising yet unproven intervention in the treatment of children with ASD. Instead, many questions remain unanswered. Will CBD be effective in the treatment of certain target symptoms in children with ASD? Will the selection of individuals who are candidates for this treatment be an important factor?
What is the most appropriate ratio of CBD to THC for the beneficial effects, if any? Well-designed research studies are being planned and underway, but results have yet to emerge. However, in science the first principle is “one finding is no finding.” Thus, even if an initial RCT demonstrates benefits in utilizing CBD for children with ASD, there would still be a need for confirmation studies.
We urge physicians to be familiar with the current state of the evidence, be able to have conversations with families and patients about the level of support, and be aware of the limitations that exist if choosing to recommend CBD as a treatment for children with ASD.