Cannabis and Autism: A Guide to Treatment and Challenges

Cannabis has been used medicinally for centuries, mostly as an alternative form of pain management. Recently researchers have turned their attention to mood and developmental disorders, including autism.

The potential positive impact of cannabis for autism spectrum disorder is significant, particularly due to the recent increase in diagnoses. The CDC reports that between 2009-2017, 1 in 6 children received an autism spectrum disorder diagnosis.

While treatment with cannabis offers challenges due to its prevalence in children, and because  it's not yet approved by the FDA, we will discuss how cannabis might help persons with autism spectrum disorder, what the research says, and where we go from here.

What is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a neurodevelopmental condition causing limited social and communicative abilities. It is referred to as a spectrum disorder because it has varying degrees of severity and symptoms.

Previously, autism was classified as autistic disorder, Asperger’s syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS), but was recently updated to ASD, as each form lies on a spectrum. Asperger’s was used to define mild, autistic severe, and NDD-NOS to define characteristics outside of the former.

What Are the Characteristics of Autism?

There are several challenges associated with autism that can cause problems in life. One of the most common symptoms is sensory processing dysfunction, which results in oversensitivity to stimuli or under-sensitivity to pain and other sensations. People on the spectrum often have trouble regulating their arousal levels because they do not adapt well to change and new situations.

Another common challenge in the autism community is aggression, which can manifest as tantrums or meltdowns. This aggression is often caused by over- or under-sensitivity to sensory stimuli, which can be a challenge in social interactions. These reactions are common in children with autism and can be difficult to manage.

Other social interaction characteristics may include:

• Having trouble making eye contact
• Avoiding looking directly at a person when interacting
• Struggling with back-and-forth conversations
• Making facial expressions or gestures that do not match the topic at hand
• Having a slow response when someone calls their name or other verbal attention-getting queues
• Difficulty understanding someone else’s point of view, or inability to understand the actions of others
• Speaking at length about a topic of their interest, and not picking up that others are not interested
• Speaking in tones that are unusual, including flat or monotone

Repetition of behavior or restricted behaviors are also common and may display as:

• A continuing interest in specific topics
• Sensitivity to sensory stimulation
• Strong reactions to small changes in routine
• Displaying an obsession with specific interests
• Repetition of behaviors or displaying abnormal behaviors

Irritability is also common in persons with ASD, as are issues sleeping. Some people with ASD have trouble sleeping through the night due to their sensitivity towards sensory input from lights or sounds in their environment. Lack of sleep can cause mood problems and increase stress even further.

Chronic pain, too, is all too common in those with ASD. A questionnaire was sent to parents of children with autism in 2016-2017. Out of over 50,000 responses, nearly 20% of respondents indicated chronic pain was experienced by their child with ASD.

How is Autism Spectrum Disorder Diagnosed?

ASD can be a challenge to diagnose. Unlike the flu, strep throat, or diabetes, there is no blood or mucosal test to determine if a person has ASD. Instead, monitoring and screening are key in making the crucial diagnosis in children.

The CDC encourages parents to watch for delayed developmental signs during infancy, known as developmental monitoring. The missing of milestones can be an indicator, making thorough communication with pediatricians and maintaining check-ups during infancy. If a milestone is missed, the pediatrician may conduct a developmental screening or comprehensive developmental evaluation to determine if the child requires intervention services, specialized treatment, or, sometimes, both.

Diagnosing in adults, too, stems primarily from monitoring by a physician and interviews. If the primary care physician feels what the patient describes may fit the criteria for ASD, the patient is typically referred to a psychiatrist or psychologist for a more in-depth evaluation, including behaviors conducted in childhood.

How is Autism Spectrum Disorder Managed?

There is no cure for ASD, though there are traditional therapies intended to help those with a diagnosis manage symptoms.

These include:

• Applied behavioral analysis, or the encouragement of positive behaviors and discouragement of negative
• Therapy, in the form of speech, social skills, or occupational

Medication, too, is used to help manage symptoms of ASD, particularly for those who struggle focusing, have anxiety or depression, or seizures. If medication is a route taken, the person with ASD, particularly if an adolescent, should be monitored for any negative side effects.

But could cannabis take the place of these medications?

The Connection Between Cannabis and Autism

Autism is a spectrum disorder and it's thought that cannabinoids like THC may help certain symptoms associated with autism. Cannabis contains many chemicals, but the compounds THC and CBD are most studied for their potential medical benefits on ASD.

Some people with autism have found relief from pain, anxiety, behavioral issues such as aggression or self-injurious behavior, and restricted interests with cannabis use. Cannabis may help reduce inflammation in the brain which is thought to be a major factor of autism symptoms related to irritability or aggression. Some people have also found that cannabis helps calm them down when they are anxious so their focus on tasks can improve as well.

Efficacy of Cannabis in Autism Spectrum Disorder

Chronic pain, sleep issues, and lack of appetite are common in persons with ASD, each of which cannabis has shown tremendous efficacies. When it comes to mood management, there are several studies that point to cannabis having positive effects for those with ASD.

For example, in a study conducted in 2018, researchers from Stanford University studied how compound anandamide levels in children with ASD compared to controls. They found that the concentration was significantly lower, a key finding as anandamide closely resembles THC in structure and functions in the same way in the endocannabinoid system. The study supports the theory that THC may hold therapeutic potential when used to treat autism symptoms.

Another study in 2013 showed endocannabinoid receptors in autistic children were found to be more active than those of healthy subjects, suggesting an imbalance within the endocannabinoid system. Researchers posited that cannabis or CBD products may serve as a therapeutic alternative to other traditional methods.

More generally, cannabis is being discussed as an effective alternative treatment for ASD. "There has been a dramatic increase in the number of children diagnosed with autism spectrum disorders (ASD) worldwide” states an article from Scientific Reports. “Recently anecdotal evidence of possible therapeutic effects of cannabis products has emerged." Cannabis has been reportedly used to help people with autism manage the symptoms that interfere with their daily lives, such as anxiety and depression. Cannabis has also been shown to be effective in helping people with autism who also experience seizures. This is important as there is a high co-occurrence of epilepsy and ASD.

Cannabis has been shown to have beneficial effects on aggressive behaviors and mood regulation difficulties associated with ASD. Cannabis may also help people sleep better at night if they suffer from insomnia related to their condition. Cannabis is known to have therapeutic effects for people with autism spectrum disorder (ASD), but the drawback of treatment is that it's not FDA-approved and therefore not legal everywhere.

One peer-reviewed study shows that cannabis can reduce any number or severity of symptoms people with autism face, including hyperactivity, self-mutilation attacks, irritability, etc. Researchers found there were improvements in cognition, sensory sensitivity, attention, social interaction, and language when cannabis was used for treatment.

While cannabis may help reduce certain symptoms related to autism, it is not a cure for ASD. Instead, it should be thought of as a potential management for ASD.

Are There Any Cannabis-Derived Drugs Approved to Treat Autism?

There are currently no cannabis-derived drugs approved to treat autism. There is evidence that suggests medical marijuana can help some patients with autism, but this evidence is largely anecdotal, and it is difficult to use observational data to make conclusions. And because autism is a spectrum disorder, cannabis may help certain symptoms but not others, or even any at all. Just like any medication, cannabis is not a one-size-fits-all solution.

The Future for Cannabis and Autism

Cannabis has been shown to have many beneficial effects for those with autism, including help with aggressive behaviors, mood regulation difficulties, pain, and insomnia related to their condition. It’s also shown to encourage improvements in cognition, sensory sensitivity, attention, social interaction, and language, all of which are common symptoms of ASD.

Despite the drawbacks of not yet being FDA-approved and therefore not being legal everywhere, cannabis has the potential to help so many people suffering from the effects of ASD. This potential is well worth further study, and as the culture and legalities change, you may see cannabis products recommended more and more for relief from the symptoms of autism.

Editor's Note: This article was originally published Jan 20, 2020 and has been updated Dec 3, 2021.