Cbd oil dosing for adhd and autism in kids

Can CBD “Calm” ADHD Symptoms?

My husband was diagnosed with ADHD [1] at 5-years-old. He is now 41. At the time, he was prescribed Ritalin. It did not work.

Yes, it “calmed” him down; however, it made him extremely sluggish, making him feel disoriented and drowsy until the effects wore-off.

This affected his grades and behavior, so school administrators placed him in “special” classes for children with behavioral problems (he constantly fidgeted and had a hard time staying in his seat). This was unfortunate because my husband is extremely intelligent and intuitive.

But, because he was placed in “special” classes and not with his peers, he fell behind in school. He was unable to reach his full potential because traditional ADHD medications failed him. This affected not only his academic success, but also his mood, self-esteem, and self-confidence.

After a couple of years on Ritalin, his mother discontinued it, but the damage was already done. He developed high blood pressure at the age of 7. The high blood pressure was a complication of the Ritalin – one he still struggles with to this day. It also took years for him to “catch up” academically.

He received his Bachelor’s degree in Technical Management in 2012 at the age of 33. But I can’t help but wonder if CBD could have helped my husband when he was a child.

I wish I would have known him as a child and I wish CBD would have been available, so he could have at least tried it. It could have made a world of difference in his quality of life. Who knows?

Lately he has tried THC-free CBD a few times, and I have noticed a difference in his behavior. After using CBD he appeared calmer and more focused, but that was only with limited use.

So, do I recommend CBD for ADHD? I cannot say. CBD may reduce ADHD symptoms, however, that is not guaranteed. Therefore, the best things you can do is research “CBD for ADHD,” and speak with your child’s doctor. She will be able to offer guidance on your child’s specific condition.

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Can CBD Help ADHD?

Some of my clients have reported a reduction in ADHD behaviors after using CBD, while others have reported little-to-no change in ADHD symptoms after repeated usage. The effect of CBD largely hinges on the severity of the condition, the symptoms, the age of the individual, body chemistry, and the CBD dosage.

Still, many of my clients who are CBD users believe that this plant-based holistic treatment has made a world of difference in their quality of life.

With the moderate-to-severe side-effects commonly associated with traditional ADHD prescription medications, these individuals welcome a treatment that comes with little-to-no long-lasting or debilitating after-effects.

Can CBD Cure ADHD?

CBD will not cure ADHD. However, research [2] suggests that full-spectrum CBD (CBD with THC) may reduce hyperactivity and improve focus in both children and adults. CBD users who suffer from ADHD tout its effectiveness and lack of severe side-effects. For my clients who have given CBD to their children with ADHD, it has been life-changing.

What Effect Does CBD Have On ADHD Symptoms?

According to my clients and personal testimonies, CBD has effectively eased their children’s ADHD symptoms, making it easier for them to manage the condition. Studies [3] suggest that cannabis or CBD (with THC) can ease ADHD-related anxiety and panic attacks.

But more research is needed before making a definitive determination on its effectiveness.

Still, the early prognosis is favorable. [3] CBD has a calming effect in the body that not only eases anxiety but also calms the mind and reduces hyperactivity and impulsivity, so you can focus. [4]

A 2016 study [5] concluded that CBD may also help with excessive worry and insomnia in children. And, a 2013 study [6] found that cannabis or CBD (with THC) may help hyperactive and impulsive children “slow down” and be more productive at home and school.

Still, it is unclear exactly how cannabis or CBD (with THC) mitigates hyperactivity and impulsivity and sharpens focus and concentration. Experts [7] believe, however, that this decrease in ADHD symptoms stems from the calming effect of THC in the body.

What Does The Research Say?

As mentioned above, research on CBD and ADHD is fairly limited. Most of what we know about CBD stems from studies [8] on cannabis (marijuana) – not CBD as a separate property and animal studies.

According to a 2013 study, [6] people who use cannabis (marijuana) regularly reported an increase in ADHD symptoms (hyperactivity, inattention, and impulsivity) when not using cannabis. However, more research is needed to fully understand the benefits of using CBD for ADHD symptom management in children.

Conversely, another study [9] found that using cannabis (in any form) can lead to substance use disorder in some adolescents with ADHD.

Still, another study [10] found that chronic and heavy cannabis use and abuse are linked to ADHD-related inattention in teens and young adults. Researchers also found that adults who were hyperactive and impulsive as children started using cannabis at an earlier age, than those, who did struggle with these behaviors. [10]

Similarly, a 2017 study [11] concluded that adolescents and young adults with ADHD are more likely to use cannabis and other recreational drugs than those without ADHD.

In summary, most studies indicate that CBD is effective at reducing ADHD symptoms (hyperactivity, inattention, and impulsivity) for children, depending on their age, body chemistry, the CBD dosage, and their symptoms.

However, there is also a risk that children may use or abuse drugs and alcohol if they begin using cannabis or CBD (with THC) before the age of 16. Children with ADHD are at risk of marijuana use disorder, addiction, and substance use disorder.

How Does CBD Work for ADHD?

CBD works with your endocannabinoid system to help it function more effectively.

It can also help reduce ADHD symptoms like carelessness, a lack of focus, hyperactivity, impulsivity, and behavioral problems.

It regulates dopamine production in your body, so you don’t experience “rebound” symptoms (inattention, hyperactivity, and impulsivity). The truth is most prescription ADHD medications can trigger a “rebound effect,” causing symptoms to worsen, instead of easing – once the effects wear-off.

Thus, CBD works by lessening or eliminating your response to depression, pain, and anxiety to make you feel “calmer” and more “stable, focused, and balanced.”

Can CBD Help with Focus and Concentration?

Yes! It can help with focus and concentration.

CBD can help an individual relax, so she can better focus and concentrate on tasks. How? Well, CBD increases the amount of dopamine in your body. Dopamine, a neurotransmitter, is responsible for memory, focus, and cognitive awareness.

If you have a hard time paying attention, remembering things, and/or concentrating, there is a good chance your dopamine levels are low. Conversely, CBD prevents your dopamine levels from rapidly declining. Thus, experts suggest that CBD can stimulate learning, by helping children pay more attention to classroom instructions.

How is CBD Beneficial for ADHD?

For some, CBD is extremely beneficial for ADHD, but for others, it has not made much of a difference in their symptoms. It just depends on the individual.

Still, many CBD users, including my clients, have reported that this plant-based compound has helped their children better manage their symptoms (agitation, hyperactivity, inattention, and impatience).

Many of my clients also reported that using CBD, as a supplement (in addition to their prescribed medications), further reduced their children’s symptoms.

However, a 2017 study, [12] found that cannabis did not appear to noticeably improve cognitive function or reduce symptoms in self-medicating adolescents and adults who used it for ADHD symptoms.

Although, there was a slight improvement in impulsivity and hyperactivity, overall, it was not significant enough to be considered more effective than the placebo given to the participants. [13]

The main benefit of using CBD for ADHD is that it produces a “calming effect” in the body and there are little-to-no side-effects for most people. [13] So, if your child is experiencing hyperactivity or a lack of focus (inattention), it may be worth trying – after you have consulted a qualified medical professional.

Unlike conventional ADHD medications like Adderall, Concerta, and Ritalin, CBD side-effects are usually extremely mild – if they occur at all.

The good news is CBD gently and gradually improves symptoms without unpleasant complications or long-term effects (addiction insomnia, decreased appetite, sluggishness, mood changes, “rebound” effects, tics, etc.).

Is It Safe For ADHD?

Yes! For most people CBD is safe for ADHD. [14]

The main concern when it comes to CBD and ADHD is if it is a safe treatment. The truth is it is the CBD (i.e. testing and purity) that is in question – not the effects of it in your body.

It is common for those who are unfamiliar with CBD to confuse it with marijuana, however, CBD is a non-addictive property found in the cannabis plant. As a result, it typically does not contain THC, the main property in marijuana; however, it may in extremely low doses (0.3 -0.6%).

But, because CBD is often confused with marijuana, many parents are reluctant to give it to their young child and teens for fear it will cause them to become addicted to it or harmed by it. That is untrue.

Keep in mind that CBD is an anti-inflammatory, so there is a risk that it may not work for a child who is struggling with ADHD. It is also important to understand that there could be an interaction between CBD and your child’s prescription ADHD medications.

At this time, there is not enough research to accurately determine CBD/drug interactions. But, experts suggest that the risk of side-effects or drug interactions is heightened in individuals who take ADHD medications or non-ADHD medications that are metabolized in the liver. [14]

Moreover, higher doses of CBD may cause a “sedating effect” in your child’s body – one that may be counteractive to managing your child’s symptoms (too drowsy, sluggish, or sleepy and/or daydreamy). [14]

As mentioned above, the main concern is the purity and accuracy of the CBD given to children for ADHD. [15] Because, CBD has not been approved for ADHD by the FDA, the amount of CBD in CBD-touted products may or may be inaccurate. Also, the CBD in these products may or may not be “pure.”

In other words, other “bulking” ingredients (pesticides, toxins, preservatives and additives, herbs, and/or high levels of THC) may be combined with the CBD, which could harm your child, especially if he or he has an allergy or sensitivity to one or more of them. [15]

It is also important to understand that CBD impacts the brain in a variety of ways, depending on the individual, so it’s unclear how it will react in your child’s body. [15] This is especially true, if the product contains “impure” CBD or CBD that has been mixed with other herbs, chemicals, supplements, pesticides, or fillers.

CBD may also be unsafe if the labeling is inaccurate, misleading, or deceptive. [15] All of these elements factor into the safety of the CBD product.

Still, CBD for ADHD has been deemed safe by the WHO (World Health Organization). In fact, according to the WHO, CBD does not appear to cause harmful or unsafe short-term or long-term effects on children or adults. [16]

Note: Research [17] suggests that individuals who struggle with ADHD and use cannabis or CBD (with THC) may be at-risk for marijuana abuse – but that is only when the CBD contains THC and the individual consumes unsafe levels of CBD in a short amount of time. This is rare.

CBD is more commonly used at safe levels and without THC, so the risk of dependency is low, if not virtually non-existent. [17]

What Are Possible Side-Effects?

Research on CBD side-effects, specifically for ADHD sufferers, is incomplete. But, most studies [18] on CBD focus on the effectiveness, benefits, and safety of CBD for epileptic children. However, these studies can still provide a glimpse of the possible side-effects for children, who struggle with ADHD.

Listed below are possible side-effects specific to children with ADHD:

According to a 2013 report, [19] parents who gave their children full-spectrum CBD or CBD with THC found that the CBD caused their children to be drowsy and fatigued. It also caused their children to have frequent headaches. This was especially true when higher doses of CBD were ingested.

Researchers also found that CBD can interact with certain ADHD medications, vitamins, and over-the-counter (OTC) drugs. [19] These findings are important because excessive drowsiness, fatigue, frequent headaches can negatively affect a child’s academic and athletic performances.

Another study [17] found that children who used cannabis (marijuana) under the age of 16 are at risk of cognitive impairment, primarily because their brains are still developing. This finding is also important because cognitive impairment can lead to developmental delays and information processing and reading comprehension issues.

The impairment could affect all or almost all areas of the child’s life (i.e. mental, personal, emotional, and academic), worsening ADHD symptoms, and lowering his self-esteem and self-confidence. Cognitive impairment can also affect a child’s social relationships, making it hard for him to make and retain friends.

  • Gastrointestinal Distress & Physiological Changes

Other than what is listed above, the side-effects remain the same across the board (for those with and those without ADHD). These side-effects include the following: diarrhea, nausea, changes in appetite or weight, dry mouth, and low blood pressure. [14] Keep in mind, however, that these side-effects are rare and usually diminish or disappear over time.

What Forms Of CBD Are Used For ADHD?

Unfortunately, at this time, there are no formal guidelines on what form of CBD to use for ADHD symptoms like hyperactivity, poor concentration, restlessness, irritability, or impulsivity.

However, CBD can be taken in a variety of ways, such as under the tongue (the sublingual approach), added to food or beverages, as cooking oil, as a muscle cream, bath bomb, or bubble bath, as aromatherapy or even as a vape (for adults). It can also be added to makeup (for teens).

The most common forms of CBD for ADHD children are sublingually (oil under the tongue), extracts, and edibles (brownies, lollipops, and gummies). This is followed by creams and supplements.

Can It Be Given To Children With ADHD?

Yes! However, studies and trials on CBD usage in children are currently limited.

Currently, Epidiolex is the only CBD prescription drug approved by the FDA for use in epileptic children. [22] The FDA has not approved any CBD forms or products for use in children with ADHD. [22]

Epidiolex is typically prescribed to children who struggle with severe, genetic, and rare forms of epilepsy. Although developed for children, it can also be used for adults with epilepsy. [22]

Keep in mind, however, that CBD “guidance” and “evidence” for treating children with ADHD stem from personal anecdotes, medical case studies, and professional observations. [23] A 2015 Facebook poll [24] found that children with epilepsy may experience noticeable improvements in sleep habits, awareness, concentration, and mood with regular use of CBD.

The good news is studies are currently being conducted on the effectiveness of CBD on other conditions, such as autism [25] and PTSD [5] in children. However, specific studies on CBD and ADHD in children are still lacking.

On the flip side, other studies [17] have indicated that children, who use or who are administered marijuana (pot) before the age of 16, are at risk of cognitive impairment, due to their underdeveloped brains.

Other studies [7] suggest that children with ADHD have a higher risk of drug and alcohol abuse or addiction. Similarly, another study [26] found that children with ADHD are twice as likely to be diagnosed with marijuana use disorder.

Note: It is unknown if these risks also apply to CBD products.

These findings are extremely important because ADHD is a cognitive-behavioral disorder, so cognitive impairment could trigger or worsen ADHD symptoms in some children.

Because CBD and ADHD in children have not been thoroughly researched, you should talk to your child’s pediatrician before giving him or her any form of CBD for ADHD.

What Are The Top 3 CBD Products for ADHD?

Choosing the best CBD product for ADHD can be confusing and overwhelming. As a result, it normally takes quite a bit of research to find the best product for your child. The good news is there are ways you can determine what products will be most beneficial for your child’s ADHD symptoms. It is important to pay attention to things like shipping costs and times, purity and the quality of the product, third-party testing results, customer reviews, and quality control.

Note: The products listed below are in no certain order.

1. Royal CBD

A popular CBD choice for ADHD that appears to work well for children is Royal CBD oil. Royal CBD boasts 100% all-natural ingredients. Their CBD oil is also lab-tested for safety, purity, and potency. It comes in a 250mg bottle, so your child does not “run out” of it too quickly.

But, if your child does not like the “woodsy” or “earthy” flavor of CBD oil, you can purchase fruit-flavored (strawberry, orange, and grape) CBD-infused gummies for him. What are the best things about these gummies?

They are THC-free and provide 10mg of CBD, per gummy. Another plus? Each bottle contains 30 gummies.

Parents who have given the CBD oil or gummies to their children, have reported that they have helped their children “calm down” and fall asleep at night.

They have also reported that the CBD has prevented their children from becoming too agitated or distracted, which has helped them focus on their homework for longer than a few minutes at a time.

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Some parents have even reported that the CBD has reduced their children’s anxiety and restlessness, which are often byproducts of ADHD.

Prices for the oil range from $49 to $229, depending on the mg. Prices for CBD-infused gummies $54 to $79.

2. CBDistillery

CBDistillery is another viable option for children with ADHD. What makes this brand reputable? Well, it sources its CBD from non-GMO, pesticide-free hemp. It also extracts the properties using CO2. Moreover, it is available in both CBD (with THC) and (THC-free), which means both adults and children can use it.

The CBD is also lab-tested for safety, purity, potency, and reliability. CBDistillery offers five different oil potencies (from 250mg to 5,000mg), along “fruity” gummies (raspberry-lemon, raspberry, and strawberry) for children and adults, who don’t like the natural “earthy” or “woodsy” flavor of CBD oil. There are 25mg or 30mg of CBD, per gummy.

Another benefit? It’s very affordable.

The downside is the oil only comes in the “natural” flavor, unlike other companies that offer flavored oils. CBDistillery products are also vegan-friendly.

Lastly, this company offers both daytime and nighttime gummy options. Customer reviews suggest that products from CBDistillery have helped with anxiety, restlessness, hyperactivity, and poor concentration.

These individuals also reported that the CBD oil or gummies helped them or their children relax, fall asleep quicker, and sleep more soundly, which significantly helped with their ADHD symptoms (distractibility, impulsivity, inattention, and hyperactivity).

The recommended dose for CBD oil for children with health conditions like ADHD is 250-500mg [27] (depending on age and weight). The oil starts at $19, which is perfect if you are on a budget or have to frequently purchase it.

The cost for a 25 count of 25-30 mg gummies is $55. The recommended dose for CBD gummies for children with health conditions (like ADHD) is 25 or 30mg, per day (depending on age and weight). A bundle pack of daytime and nighttime gummies are priced at $90.

Can’t get your child to take the oil or the gummies? No problem! CBDistillery also offers CBD in warming and cooling creams, salves, and lip balms! These products range from $6 to $80.

3. Hemp Bombs

Some customers, including a couple of my clients, suggest giving children with ADHD isolate CBD oil or THC-free CBD from Hemp Bombs. What’s so great about this company and CBD products? Well, it is sourced from 100% certified organic hemp from Europe.

It is also THC-free, so it is overall safer for children. And, like the other companies listed above, it rigorously tests for purity, potency, and consistency.

Another plus? You can discreetly add it to your child’s juice, soda, or food because it has an odorless and almost non-existent flavor. You can even cook with it! This company also offers a range of potencies in oils (from 125mg to 5,000mg). And, guess what?

Hemp Bombs offers flavored CBD oil in 6 delicious flavors (Acai berry, chocolate mint, orange creamsicle, peppermint, watermelon, and natural hemp). It also offers a wide range of fun and “fruity” gummy flavors (lemon, lime, cherry, blue raspberry, and orange) too!

Each bottle comes with a pre-measured serving of CBD, so you don’t have to figure out how much to give your child. These gummies have 15mg of CBD, per gummy, which means your child can safely take 1 or 2 of them daily and experience an improvement in symptoms.

Hemp Bomb offers a variety of gummies, from original gummies to high-potency and sleep gummies (CBD gummies infused with melatonin to help your child relax and fall asleep). It even offers CBD lollipops for children, who dislike gummies and oils.

Customers report a reduction in their children’s stress levels, a more relaxed state, lower levels of angst, increased focus and concentration, and better sleep after using the gummies or oil.

The good news is these products are also effective for adults with ADHD, although a higher dose may be required to receive the same benefits as children. Children, however, will not need a stronger dose than the 300mg bottle.

Prices for the oil range from $17 to $290 and prices for the gummies range from $15 to $140, per pack or bottle (depending on the mg and quantity).

Note: My goal is to provide CBD product suggestions that could provide your child with a better quality of life. But, because body chemistries vary, there is no guarantee that these products can or will reduce or alleviate ADHD symptoms.

How I Comprised My List of Top 3 CBD Products for ADHD

To make my selections for the top 3 therapeutic CBD products for ADHD, I researched the most popular CBD brands on the market. I looked at each brand, examining customer reviews and ratings, and third-party lab reports.

I also spoke with my clients, friends, and associates, who claim to give CBD to their children with ADHD. Based on my results, I removed various companies and products from this list until I was left with three CBD companies and products I felt were the most beneficial, reputable, and reliable for ADHD.

Is Using CBD for ADHD Legal?

CBD products for all concerns and health conditions are legal in all 50 states (to some degree). But, research your local, state, or federal laws before purchasing CBD products.

Can I Give My Child Full-Spectrum (THC) CBD for ADHD?

Yes, if you feel comfortable doing so.

Full-spectrum CBD contains between 0.3% and 0.6% THC. This is an extremely low, almost undetectable amount of CBD. However, some parents do not feel comfortable giving their children any amount of THC, which understandable.

This is a personal choice, however, full-spectrum is stronger and more concentrated, which may beneficial for severe ADHD symptoms. However, that is a personal choice after discussing the matter with your child’s pediatrician.

What is the Recommended Dosage for ADHD?

There is no “official” CBD dosage for ADHD, however, you can find the optimal dose for you or your child’s weight, age, body chemistry, and symptoms, by starting with the smallest dose (usually 2-3 drops of the oil twice a day or one 25-30mg CBD capsule or gummy daily).

If this dose does little-to-nothing for you, gradually increase the amount of CBD until symptoms diminish or disappear.

Remember, for most, CBD will only remain in the body for a few hours, which means the inattention, hyperactivity, and impulsivity will return after it wears-off. Similar to conventional ADHD prescription medications like Ritalin and Concerta, CBD must be used regularly to keep symptoms at bay.

ADHD experts [28] suggest that CBD is more effective at improving focus and reducing restlessness when combined with small amounts of THC. Small amounts (0.3% to 0.6%) of THC will not make you “high,” although it may cause you to fail a highly-sensitive drug test.

Still, the best way to combat ADHD symptoms and better manage the condition is to use full-spectrum CBD (with THC).

According to CBD users with mild ADHD, the recommended CBD dosage is 40mg of CBD daily. However, many caution that it could take between 2 and 3 weeks before your child experiences a significant reduction in symptoms.

For children with moderate-to-severe ADHD, the recommended CBD dosage should be, at minimum, 100mg daily.

CBD users suggest that the CBD be “broken up” into two doses (i.e. morning and night) and reduced after 3 weeks of use – but only if your child’s focus and behavior have improved. If you do not see a reduction in your child’s ADHD symptoms, you can increase the amount of CBD your child ingests until symptoms decrease.

Once your child’s symptoms decline or stabilize, you will want to follow that with a maintenance dose of CBD. The most common maintenance dose is 20–25mg daily.

What Is The Best & Fastest Way For Your Child to Absorb the CBD?

The best way for children to ingest CBD is under the tongue, added to food, or used as cooking oil. Parents who regularly give their children CBD for ADHD recommend that these children consume CBD orally (tinctures and edibles). [21]

Understand that oral CBD is less likely to cause side-effects, so if you are giving it to your child, it’s best to start with the tincture (oil) or edibles like candy, brownies, etc. It is also available in capsule form; however, it takes longer to experience the effects because it has to be dissolved first.

If you opt for the tincture, the best way to get maximum effectiveness is to place a few drops of the oil under your child’s tongue, wait for 60-seconds, and then instruct him to swallow the oil.

Although studies on CBD and ADHD are sparse, there have been some studies conducted on the effects of CBD on anxiety. A 2018 study [20] found that one 300-mg dose of CBD oil could reduce anxiety – a little-known effect of ADHD. But, more research is needed to determine how these results translate to other ADHD symptoms in children.

What if my child refuses to take the oil? I suggest you try edibles. Edibles like gummies dissolve fairly quickly in the digestive tract, so this may be your best option. The good news is your child will experience the effects of the CBD faster with edibles, than she would by ingesting CBD pills or using topical like creams or makeup.

If your child likes or loves gummies, this may be the best way to give him CBD. Gummies are usually colorful, tasty, and fun, which most kids love. CBD oil, on the other hand, may taste “earthy” or “woodsy,” which can be a turn-off for some kids.

The fastest way for your child to absorb the CBD is to place 2-3 drops under her tongue once or twice a day. More specifically, this is the quickest way to see an improvement in ADHD symptoms because the CBD goes directly into your child’s bloodstream.

Keep in mind, however, that it can take up to 2 hours before you see the results of the CBD. Sometimes, the effects can remain for a few hours, and sometimes they can last all day, depending on your child’s age, his body chemistry, and the severity of his symptoms.

Note: The quickest way for an adult with ADHD to experience the effects of CBD is through vaping; however, this is not the best approach. Vaping comes with a host of health side-effects and complications, so exercise caution if you decide to use this approach. Therefore, the best approach for adults with ADHD is also sublingually (under the tongue).

Regardless of the form, if your child is new to CBD, start with the smallest dose first. Then, gradually increase the dose and allow his body to adjust to it before moving up again. This will lower his risk of CBD side-effects.

In Summary…

It is important to acknowledge that no large-scale trials or studies have been conducted on the safety or effectiveness of CBD on ADHD. Therefore, there is no scientific data that supports the theory that CBD helps reduce or eliminate ADHD symptoms in children.

However, parents, who have given CBD to their children with ADHD, have reported a visible reduction in impulsivity, inattention, and hyperactivity and an improvement in focus, concentration, attention, thoughtfulness, and calmness.

According to these individuals, CBD has helped their children relax, so they can get sound sleep and awaken calmer and more focused for the day ahead.

And, while the debate rages between experts that find value in CBD for conditions like ADHD, and those, who do not, it is important to thoroughly research it before giving it to your child. You are the best advocate for your child, so ask her pediatrician for her perspective and guidance.

Also, ask parents, who give CBD to their children with ADHD, and research the various types of CBD and the side-effects of each type.

Lastly, investigate the brands to ensure they are rigorously-testing their products for safety, purity, and reliability. Don’t forget to read the product and customer reviews, because this is where you’ll find your most valuable information on if CBD eases ADHD symptoms.

The goal is to ensure that your child will be safe if she takes a particular CBD product and that it will be effective for her in both the short-term and long-term.

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Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Brazilian Journal of Psychiatry, 41(1), 9‐14. Antwi-Amoabeng, D., & Islam, R. (2020). Vaping is not safe: A case of acute eosinophilic pneumonia following cannabis vapor inhalation. Case Reports in Pulmonology, 1–5. First cannabis-based drug in the US. (2018). New Scientist, 238(3184), 7. Campbell, C. T., Phillips, M. S., & Manasco, K. (2017). Cannabinoids in Pediatrics. The Journal of Pediatric Pharmacology and Therapeutics. JPPT, 22(3), 176–185. Hussain, S. A., Zhou, R., Jacobson, C., et al. (2015).Perceived efficacy of cannabidiol-enriched cannabis extracts for treatment of pediatric epilepsy: A potential role for infantile spasms and Lennox-Gastaut syndrome. Epilepsy Behavior, 47, 138‐141. Barchel, D., Stolar, O., De-Haan, T., et al. (2019). Oral cannabidiol use in children with autism spectrum disorder to treat related symptoms and co-morbidities. Front Pharmacology, 9, 1521. Harstad, E. & Levy, S. (2014). Committee on substance abuse. Attention-deficit/hyperactivity disorder and substance abuse. Pediatrics, 134(1):e293‐e301. Devinsky, O., Marsh, E., Friedman, D., et al. (2016). Cannabidiol in patients with treatment-resistant epilepsy: An open-label interventional trial. Lancet Neurology, 15(3), 270‐278. Wong, D. F. K., Ng, T. K., Ip, P. S. Y., Chung, M. L., & Choi, J. (2018). Evaluating the effectiveness of a group CBT for parents of ADHD children. Journal of Child & Family Studies, 27(1), 227–239.

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Ree Langham, Ph.D. Psychology

Dr. R. Y. Langham holds a Bachelor of Arts in English from Fisk University, a Master of Marriage and Family Therapy (M.M.F.T.) in Marriage and Family Therapy from Trevecca Nazarene University, and a Ph.D. in Family Psychology from Capella University.

She is currently a child and family psychologist, medical, health & wellness contributor, copywriter, researcher, and psychological.

CBD-enriched cannabis for autism spectrum disorder: an experience of a single center in Turkey and reviews of the literature

Autism spectrum disorder is a neurodevelopmental disorder characterized by deficits in communication, social interaction, restricted interest, and repetitive behaviors. Although more cases are being diagnosed, no drugs are approved to treat the core symptoms or cognitive and behavioral problems associated with autism. Therefore, there is an urgent need to develop an effective and safe treatment.

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Objective

In this study, we aim to share our 2-year experience with CBD-enriched cannabis treatment in autism and review the latest studies.

Materials and methods

The study included 33 (27 males, six females) children diagnosed with autism spectrum disorder who were followed up between January 2018 and August 2020. The mean age was 7.7 ± 5.5 years. The average daily dosage of cannabidiol (CBD) was 0.7 mg/kg/day (0.3–2 mg/kg/day). The median duration of treatment was 6.5 months (3–28 months). The preparations used in this study contained full-spectrum CBD and trace elements tetrahydrocannabinol (THC) of less than 3%.

Results

The outcomes were evaluated before and after treatment based on clinical interviews. At each follow-up visit, parents were asked to evaluate the effectiveness of the CBD-enriched cannabis treatment. According to the parents’ reports, no change in daily life activity was reported in 6 (19.35%) patients. The main improvements of the treatment were as follows: a decrease in behavioral problems was reported in 10 patients (32.2%), an increase in expressive language was reported in 7 patients (22.5%), improved cognition was reported in 4 patients (12,9%), an increase in social interaction was reported in 3 patients (9.6%), and a decrease in stereotypes was reported in 1 patient (3.2%). The parents reported improvement in cognition among patients who adhered to CBD-enriched cannabis treatment for over two years. The antipsychotic drug could be stopped only in one patient who showed mild ASD symptoms. No change could be made in other drug use and doses. Additionally, this study includes an extensive review of the literature regarding CBD treatment in autism spectrum disorder. According to recent studies, the average dose of CBD was 3.8±2.6 mg/kg/day. The ratio of CBD to THC in the used preparations was 20:1. The most significant improvements were seen in the behavioral problems reported in 20–70% of the patients.

Conclusion

Using lower doses of CBD and trace THC seems to be promising in managing behavioral problems associated with autism. In addition, this treatment could be effective in managing the core symptoms and cognitive functions. No significant side effects were seen at the low doses of CBD-enriched cannabis when compared to other studies.

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that varies in severity and is characterized by deficits in communication, social interaction, restricted interest, and repetitive behaviors (Fusar-Poli et al. 2020). During the last three decades, there has been a threefold increase in the number of children diagnosed with ASD (Lihi Bar-Lev Schleider et al. 2019). Currently, it affects up to 1 in 54 individuals (Maenner et al. 2020). Cooccurring medical conditions such as epilepsy, intellectual disability, and behavior problems occur in these individuals (Pretzsch et al. 2019a; Pretzsch et al. 2019b).

The etiopathogenesis of ASD remains largely unknown. Several genetic, perinatal, and environmental factors seem to be involved. Some researchers have evidenced an imbalance in the endogenous neurotransmission system, such as the serotoninergic, γ aminobutyric acid (GABA), and endocannabinoid system (ECS), which regulate functions such as emotional responses and social interactions typically impaired in ASD (Fusar-Poli et al. 2020).

Endocannabinoids (eCBs) and their receptors are present in the nervous system, connective tissue of internal organs, glands, and immune system. Cannabinoid receptor 1 (CB1) is a G protein-coupled receptor (GPR) that is found mainly in the central nervous system (Mc Partlan et al. 2014). In mammals, high concentrations of CB1 are found in the brain area that regulates appetite, memory, fear extinction, motor responses, and postures such as the hippocampus, basal ganglia, basolateral amygdala, hypothalamus, and cerebellum (Aran et al. 2019; Mc Partlan et al. 2014). CB1 can also be found in nonneuronal cells. Data indicate that cannabinoid receptor type 2 (CB2) is linked to a variety of immune functional events. However, it may play a functionally relevant role in the central nervous system (Aran et al. 2019; Bridgemanan and Abazia 2017).

There are two endogenous cannabinoids, N-arachidonoylethanolamine (anandamide) and two arachidonoylglycerols (2-AG). The ECS has been broadened by discovering new secondary receptors, ligands, and ligand metabolic enzymes, including transient receptor potential cation channel subfamily V member 1 (TRPV1) (Mc Partlan et al. 2014).

Anandamide and 2-AG can act via CB1 and CB2 receptors and exert a range of biological effects in central and peripheral cells. Anandamide is broken down by fatty acid amide hydrolase (FAAH); inhibitors of FAAH lead to an increase in anandamide. CBD act as an inhibitor of FAAH (Bridgemanan and Abazia 2017). Endocannabinoid signaling occurs in a retrograde direction; that is, signaling is initiated in postsynaptic neurons and acts upon presynaptic terminals. In contrast to classical neurotransmitters, eCBs are not stored. They are produced on demand upon stimulation of postsynaptic cells (Aran et al. 2019; Zamberletti et al. 2017).

Interestingly, CBD displays a low affinity for CB1 and CB2 receptors. CBD facilitates excitatory glutamate and inhibitory GABA neurotransmission across the brain through agonism at the TRPV1 receptor (Pretzsch et al. 2019a; Mc Partlan et al. 2014). Additionally, CBD can increase GABAergic transmission by antagonizing G protein-coupled receptor 55 (GPR55), especially in the basal ganglia. CBD is thought to be an agonist at prefrontal serotonin 5-HT1A receptors (Castillo et al. 2012) (Fig. 1).

CBD and mechanism of action. CBD, cannabidiol; FAAH, fatty acid amide hydrolase CB, cannabinoid receptor; TRPV1, transient receptor potential cation channel subfamily V member 1; PPAR-γ, peroxisome proliferator-activated receptor-gamma; GPR, G protein-coupled receptor; GPR55, G protein-coupled receptor 55; 5-HT1A, serotonin 5HT receptor; MC4R, melanocortin 4 receptor; ROS, reactive oxygen species

Another mechanism of action can be via vasopressin and oxytocin. The presence of oxytocin in the CSF seems to originate from neuronal oxytocinergic extensions to the limbic system, brain stem, and spinal cord. Oxytocin receptors are distributed in different parts of the central nervous system, such as the basal ganglia, limbic system, thalamus and hypothalamus, and brain stem. Oxytocin modulates social behavior, motor function, pain control, memory and learning, eating behavior, stress and anxiety, and emotional processing. Oxytocin administration reduces stress and anxiety and depression in animal models. This effect seems to be modulated at least partly by the effects of oxytocin on the hypothalamic-pituitary-adrenal (HPA) axis and the opioidergic and dopaminergic systems in limbic brain structures. Several animal model studies support the role of oxytocin in improving social behavior, an effect that appears to involve the melatoninergic and endocannabinoid systems, specifically an increase in social interactions produced by agonism at the melanocortin four receptor (MC4R (Russo et al. 2005; Dos Santos et al. 2019). CBD leads to enhancement in the release of vasopressin and oxytocin; thus, it could positively affect ASD core symptoms. Studies have shown that oxytocin administration to patients with ASD improves social interactions, reduces classic repetitive behavior, and increases eye contact (Weia et al. 2015). Another mechanism of action of CBD is to act as a dopamine receptor antagonist, which can facilitate its use as an antipsychotic (Dos Santos et al. 2019; Weia et al. 2015).

CBD may act as a neuroprotectant against mitochondrially acting toxins (Davies and Bhattacharyya 2019; Bartova and Birmingham 1976). The highly lipophilic aspect of CBD gives them access to intracellular sites of action. Many studies have suggested mitochondria as targets for CBD, and many theories are based on this idea; one of these theories is that the outer mitochondrial membrane has CB1 receptors. This theory reveals that CBD affects the function of the cells by establishing homeostasis and influencing mitochondria and energy production (Bartova and Birmingham 1976; Ryan et al. 2009).

THC is known to be a major psychoactive component of Cannabis. THC is a partial agonist at CB1 and CB2 (Ryan et al. 2009). Signals through transducing G-proteins and activation of these G-proteins by THC cause inhibition of adenyl cyclase activity, the closing of voltage-gated calcium channels, and the opening of inward rectifying potassium channels. The psychoactive nature of THC limits its use due to side effects. However, a varied mixture of THC with other phytocannabinoids with very weak or no psychoactivity quality has started to be used as a therapeutic drug in humans (Bloomfield et al. 1982; Rodríguez De Fonseca et al. 1992). In this study, we aim to share our 2-year experiences with CBD-enriched cannabis treatment in autism and review the latest studies.

Methods and materials

Patients

This research was conducted in accordance with the Declaration of Helsinki at the Pediatric Clinics of Neurology in Istanbul. CBD-enriched cannabis treatment was started in 54 patients who were diagnosed with ASD. The study included 33 (27 males, six females) children diagnosed with autism spectrum disorder who were followed up between January 2018 and August 2020. The diagnosis of ASD was based on DSM V criteria (American Psychiatric Association 2013). Twenty-one participants refused to participate in this study. The most common reasons for not participating in the study were fear of adverse effects, cost of CBD-enriched cannabis, bitter taste, and behavioral problems. The mean age of the non-participating 21 children was 7.2 ± 4.2. Ten patients had mild, while 11 had severe autism according to the DSM V. Four patients were female, and 17 were male. Three children had abnormal EEG, and one was diagnosed with epilepsy, and he was on valproic acid treatment. Three patients attended mainstream schools and received their education there, while eighteen patients had intellectual disabilities. All non-participating 21 ASD patients used antipsychotic drugs. Sixteen patients used risperidone, and five patients used aripiprazole. The median duration of antipsychotic drug administration was 8.2 ± 2.6 months. The median duration of follow-up was 4.4 1 ± 1 years.

Informed consent was obtained from the parents of all children participating in the study. The mean age of the participating 33 children was 7.7 ± 5.5. Fifteen patients had mild autism, while 18 had severe autism according to the DSM V. Three patients were diagnosed with epilepsy before starting CBD-enriched cannabis; two of them used oxcarbazepine, while one used valproic acid. Seven patients had abnormal electroencephalography (EEG) results without any episodes of previous seizures. Five patients attended mainstream schools and received their education there, while twenty-eight patients had intellectual disabilities and attended schools that catered to special educational needs. Two patients were using CBD-enriched cannabis for over two years. There was no predefined duration of this treatment in our patients. All ASD patients used antipsychotic drugs. Twenty-six patients used risperidone, and seven patients used aripiprazole. The median duration of antipsychotic drug administration was 8.5 ± 2.3 months. All the patients were provided with psychosocial treatment. The median duration of follow-up was 4.6 ± 1.3 years. There were no significant differences between the 2 group profiles (participating and non-participating) regarding sex ratio, median age, and autism severity.

Treatment

The legal basis for using cannabis-related drugs is not fully apparent in Turkey, and a maximum of 0.3% THC is allowed to be used in these preparations. Due to the lack of availability and difficulty of access to these therapeutic preparations, various cannabis strains of CBD-enriched cannabis extracts have been used. The two CBD-enriched cannabis brands used were CBDistillery and CBDodgamax. Both had similar available forms of drops of 500, 1000, and 2500 mg/30 ml and contained full-spectrum CBD and trace THC. These drops were started with dosages that were calculated according to the patient’s body weight, with one sublingual drop twice a day and one drop every three days. The average daily CBD-enriched cannabis dose was 0.7 mg/kg (0.3–2 mg/kg). No patient was given a daily maintenance dose of CBD higher than 40 mg/day. The average duration of treatment was 6.5 months (3–28 months).

Results and outcomes

The outcomes were evaluated before and after treatment based on clinical interviews. At each follow-up visit, parents were asked to assess the overall effectiveness of CBD-enriched cannabis treatment. According to the parents’ reports, no change in daily life activity was reported in 6 (19.35%) patients. The main improvements of the treatment were as follows: a decrease in behavioral problems was reported in 10 patients (32.2%), an increase in expressive language was reported in 7 patients (22.5%), improved cognition was reported in 4 patients (12.9%), an increase in social interaction was reported in 3 patients (9.6%), and a decrease in stereotypes was reported in 1 patient (3.2%). The parents reported improvement in cognition in patients who adhered to CBD-enriched cannabis treatment for over two years. The antipsychotic drug could be stopped only in one patient who showed mild ASD symptoms. No change could be made in other drug use and doses.

Discontinuation and side effects

A 13-year-old male patient with severe autism had generalized seizures after using 5 mg sublingual CBD, and the drug was discontinued because of this side effect. The epileptic seizures persisted despite the discontinuation of the treatment. Interictal sleep EEG showed symmetrical bilateral frontotemporal sharp-slow wave complexes. The patient was regularly treated with valproic acid and remained seizure-free after starting this antiepileptic drug. CBD-enriched cannabis was also discontinued in a nine-year-old male patient with severe autism after two weeks because of a significant increase in stereotypes. No change in laboratory values related to CBD-enriched cannabis was found in any patient.

Restlessness was the only reported side effect in 7 (22%) out of 31 patients who continued treatment for at least three months, and the CBD-enriched cannabis dose was reduced in these patients. As the amount was reduced, restlessness decreased.

A review of other studies

The popularity of CBD-enriched cannabis for the treatment of autism is increasing. Scoping reviews were done to achieve a broad and thorough examination of the literature in this area. Aran et al. (2019) were the first to retrospectively assess CBD-enriched cannabis effects on 60 children with ASD and severe behavioral problems using an open-label cohort study. The mean age was 11.8 ± 3.5 years; 82% of patients used psychiatric medications; 77% of patients had low cognitive function; and 23.3% of patients had epilepsy. All the children received CBD and THC in a 20:1 ratio. The mean total daily dose was 3.8 ± 2.6 mg/kg/day CBD and 0.29 ± 0.22 mg/kg/day THC for children who received three daily doses (n=44) and 1.8 ± 1.6 mg/kg/day CBD and 0.22 ± 0.14 mg/kg/day THC for children who received two daily doses (n=16). The doses were titrated over 2–4 weeks. The mean follow-up period was 10.9 ± 2.3 months. Efficacy was assessed using the Caregiver Global Impression of Change (CaGI) scale. Considerable improvement in behavioral problems was noticed in 61% of patients. Improvement in anxiety and communication problems was seen in 39 and 47%, respectively. Based on these promising results, Aren et al. launched a new placebo-controlled crossover trial. This study is ongoing, and new outcomes will be addressed in future publications (Aran et al. 2019).

Another study was conducted to evaluate the efficacy and safety of CBD-enriched cannabis effects on autism. This prospective, open-label study was carried out by Lihi Bar-Lev Schleider et al. and included 188 patients. The mean age was 12.9 ± 7 years. A total of 14.4% of patients had epilepsy. Most patients used preparations with 30% CBD and 1.5% THC, and the average concentrations of CBD and THC were 79.5 ± 61.5 mg and 4.0 ± 3.0 mg, respectively. After one month of treatment, 179 patients adhered to the treatment, and only 119 patients could be evaluated. Significant improvement was reported in 48.7% of patients, moderate improvement was reported in 31.1% of patients, and no change was reported in 14.3% of patients. Side effects were reported in 5.9% of patients. After 6 months of treatment, 155 patients continued treatment with CBD. Of the latter group, 93 patients responded to the questionnaire, 30.1% reported significant improvement, 53.7% reported moderate improvement, 6.4% reported slight amelioration, and 8.6% of the patients reported no change. Quality of life, mood, and ability to perform daily living activities were evaluated before the treatment and at 6 months. A total of 31.3% of the patients reported good quality of life before treatment. After 6 months, this percentage increased up to 66.8% (Lihi Bar-Lev Schleider et al. 2019).

Paulo Fleury et al. (2019) conducted a prospective, observational, and open-label study with a cohort of 18 autistic patients who received CBD-enriched cannabis (with a CBD-to-THC ratio of 75/1). The average dose of CBD was 4.55 mg/kg/day (a minimum of 3.75 mg and a maximum of 6.45 mg/kg/day). The average THC dose was 0.06 mg/kg/day (a minimum of 0.05 and a maximum of 0.09 mg/kg/day). The mean age was ten years. Fifteen patients adhered to the treatment (10 nonepileptic and five epileptic), and only one patient showed a lack of improvement in autistic behaviors. The most significant improvements were reported for seizures, attention-deficit/hyperactivity disorder, sleep disorders, communication, and social interaction (Paulo Fleury et al. 2019). Barchel et al. (2019) performed an open-label study on 53 autistic children. The median age was 11 (4–22) years; these patients received CBD at a concentration of 30% and a 1:20 ratio of CBD to THC. The median THC interquartile range (IQR) daily dose was 7 (4–11) mg, and the median CBD (IQR) daily dose was 90 (45–143) mg. The median duration of treatment was 66 days (30–588). Self-injury and rage attacks improved by 67.6% and worsened by 8.8%, respectively. Improvement in hyperactivity symptoms was reported in 68.4% of patients, 28.9% reported no change, and 2.6% reported worsening symptoms. Sleep problems improved by 71.4% and worsened by 4.7%. There was an improvement in anxiety in 47.1% and worsening in 23.5% of patients (Barchel et al. 2019). Mojdeh Mostafavi et al. (2020) reported positive effects of cannabis in ASD, especially in aggressive and self-injurious behaviors (Mostafavi and Gaitanis 2020). McVige et al. (2020) carried out an important retrospective and open-label study on 20 patients with ASD (6 with epilepsy and 14 with pain). These patients were on cannabis treatment. The study reported very significant positive outcomes. The Autism/Caregiver Global Impression of Change (ACGIC) scale revealed improvements in sleep, mood, and aggression toward the self or others; there were also improvements in patient communication abilities and attention/concentration (McVige et al. 2020).

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According to Aren et al.’s study, adverse events such as hypervigilance aggravated sleep disturbances in 14% of patients. This side effect was resolved by omitting or adjusting the evening doses. Irritability in 9% and loss of appetite in 9% were seen. A thirteen-year-old girl received 6.5 mg/kg/day CBD and no other medications; when she gradually increased the THC dose up to 0.72 mg/kg/day, she developed sudden behavioral changes such as unusual vocalization and refusal to sleep and eat for two days. The symptoms resolved when she stopped CBD and THC and received antipsychotic treatment (ziprasidone). After cannabis treatment, psychiatric medications were regulated in most patients; 33% received fewer or lower doses, 24% stopped taking medications, and 8% received more medication or higher doses (Aran et al. 2019). Lihi Bar-Lev Schleider et al. reported mild side effects such as restlessness, sleepiness, dry mouth, and digestion problems (Lihi Bar-Lev Schleider et al. 2019). Paulo Fleury et al. reported that three patients stopped using CBD-enriched cannabis in a period shorter than one month due to side effects (autistic behaviors had worsened in two patients, which might happen due to the unsupervised and sudden cessation of the antipsychotics; one patient had insomnia, irritability, increased heart rate, and worsening of psych-behavioral crises that might be due to the interaction of cannabis with previous prescribed antipsychotic drugs). Mild and transient adverse effects such as sleepiness, moderate irritability, diarrhea, increased appetite, conjunctival hyperemia, and increased body temperature were also reported (Paulo Fleury et al. 2019).

Discussion

In the updated review, preliminary evidence announcing that cannabinoids (compounds with different ratios of CBD and THC) could exert beneficial effects on some ASD-associated symptoms, such as behavioral problems, hyperactivity, and sleep disorders, with a lower number of metabolic and neurological side effects than approved medications. Importantly, treatment with cannabinoids permits a reduction in the number of prescribed drugs and significantly reduces the frequency of seizures in participants with comorbid epilepsy. In this paper, we aimed to make some critical points related to the main findings and mechanisms of action of cannabinoids, such as a decrease in behavioral problems, an increase in the expressive language, an improvement in cognition, and an increase in social interaction when patients used CBD-enriched cannabis at a dose of 0.7 mg/kg (0.3–2 mg/kg), which is lower than the doses reported in other studies. Furthermore, these results are consistent with other studies that suggest that supplementing ASD patients with CBD-enriched cannabis could improve behavioral problems. A dose of 3.8 ± 2.6 mg/kg/day CBD was used in Aren et al.’s study and yielded improvements in anxiety and communication problems. According to Paulo Fleury et al., the average dose of CBD was 4,55 mg/kg/day, and the results showed that only one patient reported no improvement in autistic behaviors. The most significant improvements were reported for seizures, attention-deficit/hyperactivity disorder, sleep disorders, communication, and social interaction. In addition, improvements in expressive language were seen. CBD-enriched cannabis might help children with ASD via several possible mechanisms, including its anxiolytic and antipsychotic properties and its impact on the endocannabinoid system (ECS) and oxytocin (Dos Santos et al. 2019; McVige et al. 2020; Premolia et al. 2019). According to our results, we recommend using lower doses of CBD-enriched cannabis.

CBD use is not devoid of health risks; known risks include liver damage, adverse effects on the male reproductive system, potential drug interactions that may be associated with adverse events or diminished efficacy of approved therapies, and additional unknown health risks. However, the pharmacology of CBD has not been well studied; thus, little is known about both the potential therapeutic benefits and the hazards of short- or long-term use (Leas et al. 2020). According to our study, restlessness was the only mild side effect seen in some patients which was resolved on making some doses adjustments. In addition, generalized seizures after starting CBD-enriched cannabis. And these seizures re-occurred even several months after cessation of CBD treatment, and abnormal EEG results were seen. Therefore, this study cannot make causal inferences on the relation between CBD-enriched cannabis and seizures. Not all patients benefit equally from the use of CBD. The reason why some patients experienced benefits while others experienced side effects could be due to candidate genes that may influence the acute effects of cannabis. Genes posited to have specific influences on cannabis include CNR1, CB2, FAAH, MGL, TRPV1, and GRP55. When some patients have a mutation in these receptors, different results could be seen when cannabis was used (Agrawal and Lynskey 2009). Other studies also reported reversible and some mild side effects, none of which were life-threatening. Most of the side effects were overcome by adjusting the doses. Furthermore, the use of recreational cannabis in adolescents is associated with several risks, including decreased motivation, addiction, mild cognitive decline, and schizophrenia. However, these complications are all attributed to THC. Our study drug was full-spectrum CBD and trace THC. Nevertheless, systematic evaluation of safety data of CBD use in children is still lacking. Future research is recommended that examines the clinical impact of CBD-enriched cannabis. Additionally, rarer side effects were seen in our patients compared to other studies, which could be due to using lower doses of CBD and trace THC (a brief overview of all these studies is given in Tables 1 and 2).

These preclinical data and the current study results render further exploration of this treatment avenue in controlled studies. Until such evidence is available, physicians should be cautious when using medical cannabis to treat children with ASD since initial reports of promising treatment in children with ASD are often found.

Limitations of the study

The absence of the control study group, the use of various strains of CBD-enriched cannabis extracts, different durations of treatment and dosages, and depending on the reports of the parents instead of standard assessment scales are considered to be the main limitations of the study. The clinical assessments were done with knowledge of the patients’ treatment (it was an open-label case series, not a blinded clinical trial.

Conclusion

Using lower doses of CBD and trace THC seems to be promising in the management of behavioral problems associated with autism. In addition, this treatment could be effective in managing core symptoms and cognitive functions. No significant side effects were seen at the low doses of CBD-enriched cannabis when compared to other studies.

Availability of data and materials

The datasets used and analyzed in this review article are available from the corresponding author upon reasonable request.

CBD: What Parents Need to Know

Parents are giving it to kids to combat anxiety and other problems. But there are risks, and little research to support it.

What You’ll Learn

  • Is CBD safe for kids?
  • What are the risks of giving kids CBD?
  • Can CBD help kids who have mental health disorders?
  • Quick Read
  • Full Article
  • What do we know about CBD?
  • Concerns about CBD
  • Is CBD safe?
  • CBD oil for anxiety
  • CBD and autism
  • Research boom

Quick Read

These days, you can find CBD everywhere. Some people believe that it can treat everything from chronic pain and cancer to anxiety and ADHD. But is it safe for kids?

CBD is still pretty new, so there’s very little research about its safety or how well it works, especially for children. So far, there’s only one marijuana-derived medication that has been approved by the Food and Drug Administration. It’s called Epidiolex, and it’s used to treat a rare form of epilepsy in patients who are at least two years old.

Because CBD is so new, there also aren’t a lot of rules about what can and cannot be included in CBD products. So, there’s a huge variety in the quality of products. You may even find different amounts of CBD in different packages of the same product.

Since there isn’t a lot of research about CBD, doctors say there are some risks with using CBD for kids. For example, CBD products may contain things other than CBD, and those things could be harmful. Plus, we don’t yet know if CBD works well with other medications or how much you should give your child.

Although a few studies have found that CBD oil might work for anxiety, they only looked at healthy people who were put in situations that made them anxious. There are no studies yet on people with chronic anxiety. Researchers are also exploring CBD for kids with autism spectrum disorder. The results are good so far, but more research needs to be done before we can know if it’s safe and effective.

CBD is everywhere. From corner stores and bars to medical marijuana dispensaries, it’s being offered for its reputed ability to relieve pain and make people feel better.

Though CBD — full name cannabidiol — is extracted from marijuana or hemp, it doesn’t contain THC, the chemical in marijuana that has psychoactive effects, so it doesn’t make you feel high.

Available in the form of vaping, oils, lotions, cocktails, coffee, gummies — you name it — CBD has been touted as a treatment for complaints as far-reaching as chronic pain, cancer, migraines, anxiety and ADHD. You know it’s gone mainstream when even Consumer Reports has issued guides on how to shop for CBD and tips for safe CBD use.

Not only are adults experimenting with CBD for whatever is bothering them, increasingly parents are turning to CBD to help their kids focus, sleep, calm down and more.

But popular use of CBD is blowing up with very little research into its safety or its efficacy, especially in children. The first and only marijuana-derived drug approved by the Food and Drug Administration, Epidiolex, is used to treat a rare, severe form of epilepsy in patients two years of age and older. And since cannabis is in the early stages of legalization and regulation, there is a huge variety in the quality and dosage of products — risks associated with using products that have not been vetted by the FDA.

What do we know about CBD?

For millennia, hemp plants have been used for medicinal purposes around the world. In 1851 marijuana was classified by the United States Pharmocopeia as a viable medical compound used to treat conditions like epilepsy, migraines and pain. But since marijuana and cannabis-related products were made illegal in the US in 1970, there has been a dearth of research about either marijuana or CBD. Its classification as a Schedule 1 drug made it nearly impossible to get federal funding to study cannabis.

“The biggest problem is there’s a lot that we still need to know, especially in kids,” says Paul Mitrani, MD, a clinical psychiatrist at the Child Mind Institute. “In regards to treating mental health disorders in children and adolescents, there’s a lack of evidence to support its use.”

Dr. Mitrani, who is a pediatrician and child and adolescent psychiatrist, says it’s an area worthy of investigation but recommends that parents wait until further research is done before giving a child CBD.

Concerns about CBD

While anecdotal evidence of the benefits of CBD is common, there are risks associated with using these products, especially in children. Some of the concerns:

  • Products are unreliable in delivering a consistent amount of CBD. They could have less, or more, than advertised, and most do not offer independent verification of active contents. Analysis of products for sale show that many do not have the amount of CBD that they advertise. “So you can’t depend on the quality of what you’re getting,” notes Dr. Mitrani.
  • How much is absorbed? Very little is known about how much CBD is actually delivered to the brain in a given product. Various delivery systems — vaping, taking it orally, eating it in baked goods, etc. — have different rates of delivery. Even the oils that the CBD is dissolved in can result in varying effects. “Effects can vary a lot based on the delivery system used and the amount people are exposed to can be inconsistent,” Dr. Mitrani says.
  • Products may contain things other than CBD, and they could be harmful. Lab testing — which provides information about CBD levels, THC levels (if any), and contaminants in the product — isn’t mandatory for CBD products in every state. Without a CoA (Certificate of Analysis) it’s that much harder to verify the safety of the product. Bootleg CBD may be connected to recent lung illnesses and deaths that have been attributed to vaping. The CDC and the American Medical Association recommend avoiding vaping entirely while the cause of these illnesses is determined.
  • CBD may be safe itself, but it may interact with other medications a child is taking, that are also metabolized in the liver.
  • If it’s used for sleep, Dr. Mitrani worries that while it may potentially help with sleep, “your child may become tolerant to it and possibly experience worsening sleep problems if stopped.”
  • Since CBD use — especially for kids — is a still so new, few people are familiar with dosing for children, so determining how much to give your child would be tricky. Clinical doses versus what you might find at a coffeehouse could vary dramatically.
  • The legality of cannabis products and CBD is still murky. CBD derived from hemp is federally legal, while CBD derived from marijuana plants is subject to the legal status in each state — and remains federally illegal. Meanwhile, the FDA issued a statement making clear that products that contain CBD — even if they are derived from legal, commercial hemp — cannot claim to have therapeutic benefits or be sold as dietary supplements unless they have been approved by the FDA for that use.

Is CBD safe?

Last year the World Health Organization, acknowledging the explosion in “unsanctioned” medical uses of CBD, reviewed the evidence for its safety and effectiveness. The WHO report concluded that “CBD is generally well tolerated with a good safety profile.” Any adverse effects could be a result of interactions between CBD and a patient’s existing medications, the WHO noted.

The report found no indication of potential abuse or dependence. “To date there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.”

As for effectiveness, the WHO noted that several clinical trials had shown effectiveness for epilepsy, adding: “There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”

CBD oil for anxiety

In 2015 a group of researchers led by Esther Blessing, PhD, of New York University, investigated the potential of CBD for treating anxiety. In a review of 49 studies, they found promising results and the need for more study.

The “preclinical” evidence (ie from animal studies) “conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders,” Dr. Blessing wrote. Those include generalized anxiety disorder, PTSD, panic disorder, social anxiety disorder and OCD.

The review notes that the promising preclinical results are also supported by human experimental findings, which also suggest “minimal sedative effects, and an excellent safety profile.” But these findings are based on putting healthy subjects in anxiety-producing situations and measuring the impact of CBD on the anxiety response. Further studies are required to establish treatment with CBD would have similar effects for those who struggle with chronic anxiety, as well as what the impact of extended CBD use may be.

“Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders,” Dr. Blessing concludes, “with need for further study of chronic and therapeutic effects in relevant clinical populations.”

CBD and autism

A group of Israeli researchers have been exploring the use of CBD to reduce problem behaviors in children on the autism spectrum. A feasibility study involving 60 children found substantial improvement in behavioral outbreaks, anxiety and communication problems, as well as stress levels reported by parents.

The researchers, led by Adi Aran, MD, director of the pediatric neurology unit at Shaare Tzedek Medical Center, went on to do a double-blind, randomized, placebo-controlled trial with 150 participants with autism. In this trial, just completed but not yet analyzed, patients were treated CBD for three months.

Research boom

In the US, research has been given a boost by changing guidelines and laws. In 2015 the DEA eased some of the regulatory requirements that have made CBD, as a Schedule 1 substance, difficult to study. “Because CBD contains less than 1 percent THC and has shown some potential medicinal value, there is great interest in studying it for medical applications,” the DEA said in announcing the change.

And in approving the first CBD-based drug, Epidiolex, last year the FDA expressed enthusiasm for the research boom that is sure to come, paired with stern words for the flood of marketers of products claiming unsubstantiated health benefits.

“We’ll continue to support rigorous scientific research on the potential medical uses of marijuana-derived products and work with product developers who are interested in bringing patients safe and effective, high quality products,” the FDA pledged. “But, at the same time, we are prepared to take action when we see the illegal marketing of CBD-containing products with serious, unproven medical claims.”