Autism/Asperger Syndrome

Autism, also called “autism spectrum disorder” (AUD), is a neurodevelopmental disorder characterized by difficulties socializing and communicating, processing and understanding external stimuli, and repetitive behaviors. There is no treatment for autism per se, and many people feel that autism is a difference in how an individual’s brain works (“neurodivergence”) as opposed to a medical condition. Endocannabinoid system (ECS) dysregulation and lower circulating endocannabinoid levels are characteristics of autism.

What is Autism?

Autism is thought to exist on a spectrum to some extent. However, all types of autism, whether “low” or “high” functioning, seem to have one particular symptom in common: extreme sensitivity to external stimuli. Some find ways to manage this, while others sadly do not. Those who can function in the “neurotypical world” are labeled “high functioning,” whereas those who are unable to live independently are labeled “low functioning.”

Is Asperger Syndrome on the Autism Spectrum?

While some delineate between Autism and Asperger Syndrome, many have incorporated the once-separate (often considered a sub-type) Asperger’s or Asperger Syndrome under the umbrella of Autism. Also, although they are still sometimes used, the terms high-functioning autism (HFA) and low-functioning autism (LFA) are slowly falling out of use as the signs and quality of life issues in those living with HFA or LFA can overlap.

Autism can cause sensory processing difficulties as it alters how nerve cells and synapses connect and organize. Evidence suggests that those with autism are more likely to experience synesthesia, implying an extreme sensitivity to light, taste, touch, and sound and a “crossing” or “joining” of the senses to some degree. However, autism is characterized by impaired social interaction and communication and restricted and repetitive behavior. Extreme anxiety and an inability to easily understand others is also a symptom of autism.

The CDC reported that approximately 1 in 44 children in the U.S. is diagnosed with an autism spectrum disorder (ASD), according to 2018 data. Due to its relationship to fragile X syndrome (FXS), boys are more likely to be affected by more severe forms of autism than girls. FXS is caused by mutations in the FMR1 gene, leading to little-to-no familial fragile X messenger ribonucleoprotein (FMRP) being produced. This leads to altered synaptic plasticity.

Brief Summary of Current Treatments

Current treatments for those with autism include a variety of physical, occupational, and psychosocial models of therapy, including:

• Behavioral management therapy
• Cognitive behavior therapy
• Early intervention
• Educational and school-based therapies
• Joint attention therapy
• Occupational therapy
• Parent-mediated therapy
• Physical therapy
• Social skills training
• Speech-language therapy

The only two medications approved for managing signs associated with autism are:

1. Aripiprazole (Abilify)
2. Risperidone (Risperdal)

These are both antipsychotics, and they are prescribed to reduce behavior problems like aggression or self-injury. Other medications that may be prescribed include antidepressants like fluoxetine (Prozac) and stimulants like amphetamine/dextroamphetamine (Adderall).

Although there is no special diet for those with autism, the gluten-free, casein-free (GFCF) diet is used by some to manage health problems associated with autism.

How Might Medical Cannabis Help?

Cannabis may help autism in several regards. One, cannabis could help regulate synapse signaling in those with autism. Mutations of the protein neuroligin-3 found in those with autism can interfere with endocannabinoid signaling in the brain.

Two, CBD could help modulate the immune system, which is found to be dysregulated in those with autism. Those with autism also see shifts in their gut microbiota and are prone to irritable bowel syndrome (IBS). Again, cannabis could help treat these symptoms.

Three, those with autism are often prescribed a mixture of antidepressants, antipsychotics (e.g., risperidone, aripiprazole), and stimulants (e.g., amphetamine or dextroamphetamine). These all have significant side effects compared to cannabinoid-based medications and could be reduced or replaced by the appropriate utilization of medical cannabis.

Four, phytocannabinoids like tetrahydrocannabinol (THC) and cannabidiol (CBD) may help improve mood and reduce anxiety. So there are several ways cannabis may help with autism, and more research is needed to precisely determine how and in what way.

Cannabinoids

• THC may help increase anandamide production.
• One study found that CBD-enriched cannabis improved the quality of life for those with autism, including social interaction, decreased behavioral problems, and increased expressive language.
• A combination of CBD, THC, cannabidiolic acid (CBDA), and tetrahydrocannabinolic acid (THCA) may be helpful.

Cannabinoid Ratios

• THC:CBD 1:20
• THC:CBD 1:1
• THC:CBD 2:1
• THC:CBD 4:1
• THC:CBD 5:1

Terpenes and Terpenoids

• Borneol: One study found that a patented intranasal herbal formula, including borneol, improved behavioral problems and enhanced immunological function in children with autism.
• Myrcene: Its sedative properties may help relieve anxiety and insomnia.
• Eucalyptol (aka 8-cineole): This compound has gastroprotective properties, which could help manage IBS and IBD, which are more common in those with autism.

Flavonoids

• Luteolin
• Quercetin

One clinical trial has found that these anti-inflammatory flavonoids could help improve communication, daily living skills, and socialization in children with autism.

Effective Ways of Taking Medical Cannabis for Autism/Asperger Syndrome

Routes of Administration

• Sublingual
• Ingestion

Special Formulations

There are two products available in Louisiana; Washington, D.C.; Pennsylvania, and Australia made with an autism spectrum disorder in mind: Hope 1 & 2 by Zelira. Hope 1 is a THC:CBD 1:1 tincture, and Hope 2 is a THC:CBD 5:1 tincture. Olive oil is the carrier oil in both.

Kyle Kushman developed a variety of cannabis named “The Alexander” (aka Joey’s Strain), specifically with autism in mind.

There are several different THC:CBD ratios that may help manage autism. The ideal ratio and dosage depend very much on the individual.

Dosing Methods

• Oil-based tincture
• Edibles

What are the Pros and Cons of Taking Medical Cannabis for Autism/Asperger Syndrome?

Potential Pros

• Low doses of THC have an anxiolytic (anti-anxiety) effect, easing the stress of overstimulation and social interaction and preventing the likelihood of repetitive or self-injurious behavior.
• Could cannabis help synesthesia be more pleasurable/tolerable.
• Could help reduce or replace the need for antidepressants, antipsychotics, and stimulants, many of which have negative side effects, are not best taken together in the first instance and may be contraindicated for adults.
• Cannabis may help regulate synapse signaling problems in autistics, particularly anandamide signaling.
• Blocking CB1 receptors can relieve seizures, memory issues, anxiety, and other problems associated with Fragile X Syndrome.
• Some suggest that those with autism have an awry default mode network (DMN). The default mode network (DMN) is a network of interacting brain regions active when a person is not focused on the outside world, measurable with the fMRI technique. Could cannabinoids help reset the DMN to some extent? More information about the default mode network and its relationship to conditions like PTSD, depression, and addiction is available.
• Immune system dysregulation is also present in those with autism, and phytocannabinoids’ immunomodulatory and anti-inflammatory effects may help re-regulate the immune system.
• High doses of CBD may help prevent overstimulation and have sedating effects.
• CBD and THCA may help prevent overstimulation and seizures – epilepsy and autism share some genetic mutations.

Potential Cons

• Large amounts of THC may increase anxiety in some.
• May also induce overstimulation of the senses.
• The right cannabinoid-terpenoid profile must be used, or cannabinoids may prove ineffective – a mixture of both THC and CBD is ideal.
• Too little CBD may be overstimulating, as CBD can indirectly antagonize CB1 receptors in low doses – higher doses of CBD may be needed to manage signs and symptoms of autism.
• There is little evidence of cannabis’ efficacy for high-functioning autism, although some benefits such as improved sleep, appetite, and decreased anxiety may still be.
• Restlessness and anxiety may increase in some instances.

Useful Anecdotal Information

Hess, Peter. “Cannabis and autism, explained,” Spectrum News

Angley, Natalie. “Medical marijuana and autism: ‘I’m getting my boy back,’ mom says,” CNN Health, Dec. 20, 2021

“Can medical cannabis help kids with autism?,” 10 Tampa Bay

Bushak, Lecia. “Autistic Boy Thrives After Using Customized Medical Marijuana: How ‘Joey’s Strain’ Saved His Life.” Medical Daily, May 3, 2014

Scientific Data Overview and Studies

• Total Studies = 33
• Positive Studies = 26
• Inconclusive Studies = 6
• Negative Studies = 1
• 19 Meta-Analyses (14 positive, 5 inconclusive); 7 Animal Studies (all positive); 3 Double-Blind Human Trials (2 positive, 1 inconclusive); 3 Human Trials (all positive); 1 Lab Study (Negative)
• 16 studies include CBD (13 positive, 3 inconclusive); 11 studies include THC (10 positive, 1 inconclusive); 1 study includes THC:CBD 1:1 (positive)
• Possible Overall Efficacy: Moderate to high

Quotes from Studies

“There has been a dramatic increase in the number of children diagnosed with autism spectrum disorders (ASD) worldwide. Recently anecdotal evidence of possible therapeutic effects of cannabis products has emerged. The aim of this study is to characterize the epidemiology of ASD patients receiving medical cannabis treatment and to describe its safety and efficacy. We analysed the data prospectively collected as part of the treatment program of 188 ASD patients treated with medical cannabis between 2015 and 2017. The treatment in majority of the patients was based on cannabis oil containing 30% CBD and 1.5% THC. Symptoms inventory, patient global assessment and side effects at 6 months were primary outcomes of interest and were assessed by structured questionnaires. After six months of treatment 82.4% of patients (155) were in active treatment and 60.0% (93) have been assessed; 28 patients (30.1%) reported a significant improvement, 50 (53.7%) moderate, 6 (6.4%) slight and 8 (8.6%) had no change in their condition. Twenty-three patients (25.2%) experienced at least one side effect; the most common was restlessness (6.6%). Cannabis in ASD patients appears to be well tolerated, safe and effective option to relieve symptoms associated with ASD.”

Source: Bar-Lev Schleider, Lihi et al. ‘Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy‘ Scientific reports vol. 9,1 200. 17 Jan. 2019, doi:10.1038/s41598-018-37570-y

“Currently, there are no approved medications for the core symptoms of ASD and only two medications Food and Drug Administration approved for associated irritability. Prescribed medications for symptoms associated with ASD display varying levels of efficacy, safety, and tolerability among the heterogeneous ASD population. At the time of this study there are no published placebo-controlled trials of medical cannabis for ASD and the observational studies have limitations. CBD-rich medical cannabis seems to be an effective, tolerable, and relatively safe option for many symptoms associated with ASD, however, the long-term safety is unknown at this time.”

Source: Holdman R, Vigil D, Robinson K, Shah P, Contreras AE. “Safety and Efficacy of Medical Cannabis in Autism Spectrum Disorder Compared with Commonly Used Medications.” Cannabis Cannabinoid Res. 2021 Aug 24. doi: 10.1089/can.2020.0154. Epub ahead of print. PMID: 34432543.

Conclusion

There is good evidence that medical cannabis could help manage autism and improve quality of life measures like communication, daily living skills, and socialization. Moreover, compared to antipsychotic medications, medical cannabis presents a more tolerable adjunct or alternative as it has fewer adverse effects. There is certainly enough evidence to encourage the study of the potential benefits of medical cannabis extracts for managing autism on a broader scale.

Related Articles

Cannabis for Autism: A Meta-Analysis of the Research

Medical Cannabis is Working for Autistic Children

Please note that the information in this article does not constitute medical advice.

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