“Autism spectrum disorder (ASD) is the name for a group of developmental disorders. ASD includes a wide range, “a spectrum,” of symptoms, skills, and levels of disability.”
-National Institute of Mental Health
Autism spectrum disorder (ASD) is a treatment-resistance disorder that has a huge impact on lives globally. Like many treatment-resistant ailments (e.g. seizures, fibromyalgia, migraines), doctors don’t seem to know much about ASD. It’s in these scenarios that they should start scrutinizing the accepted treatment model, and further explore often-overlooked biological systems for clues. One of these oft-overlooked systems is the endocannabinoid system (ECS). The ECS is an important and complex biological communication network that uses receptors and mobile cannabinoids to regulate many other systems in our bodies.
Let’s review the signs and symptoms of ASD so we can better relate them to dysfunctions/disorders of the ECS.
Characteristic traits of Autism Spectrum Disorder (ASD) may include:
- Communication/social deficits
- Empathy/”theory of mind” deficit
- Social stimuli less rewarding
- Restricted patterns of interest/activity
- Repetitive behavior
- Abnormal sensory perception
- A-typical sleep patterns/circadian rhythm
- Reduced circulating melatonin
As many as 1 in 68 (1.6 %) 8-year-old children receive an ASD diagnosis, with a male: female ratio of 4:1 (CDC 2010). Co-morbidities often include intellectual disability (60%), anxiety (56%), and seizure (30%). These are similar to other known ECS dysfunction symptoms and comorbidities (Chakrabarti et al. 2015).
Unfortunately, ASD is:
- Not well understood
- Not easily diagnosed
- No definitive tests for a clinical diagnosis
- No definitive tests for a clinical diagnosis
- Very complicated
ASD strengths and abilities may include:
- Having above-average intelligence (around 40% according to the CDC)
- Being able to learn things in detail and remember information for long periods of time
- Being strong visual and auditory learners
- Excelling in math, science, music, or art
ASD and the Endocannabinoid System
“…the endocannabinoid system controls emotional responses, behavioral reactivity to context, and social interaction. Thus, it can be hypothesized that alterations in this endogenous circuitry may contribute to the autistic phenotype. ”
According to research, ASD is most probably a disruption in the endocannabinoid system. Let’s look closer:
Because of the Endocannabinoid system’s (ECS) strong influence on emotional and behavioral response and social interaction, research has long suggested a link between the ECS and ASD.
As we know our body possesses naturally occurring cannabinoids (known as endocannabinoids, or eCBs). These naturally occurring cannabinoids (eCBs) are components of our ECS, and act as mobile “messengers” to regulate our overall health. “Anandamide (AEA)” is one of these naturally occuring eCBs, and has been shown to influence social reward stimulation.
ASD is neuro-developmental in nature.
Research suggests that ASD brains have “neuroligin” mutations which causes a-typical neuronal development, pruning, and wiring (Belmonte MK.et al., 2004). These mutations may also cause a disruption in eCB signaling specific to social reward and interaction (Jaramillo TC. et al., 2014.).
“These abnormalities are suggestive of derangements occurring during the first/second trimester of pregnancy, namely reduced programmed cell death and/or increased cell proliferation, altered cell migration, abnormal cell differentiation with reduced neuronal body size, abnormal neurite sprouting, and pruning that result in atypical cell–cell wiring. In addition, neurodevelopmental mechanisms extending into late prenatal/postnatal life include reduced synapse formation and delayed myelination.”
Research has also proposed that the antipyretic drug, acetaminophen, the active ingredient in Tylenol and Excedrin, is metabolized into a potent inhibitor (AM404) of an eCB membrane transporter. This inhibition causes a disruption in the amount of naturally circulating cannabinoids (like anandamide), which may interfere with neurodevelopment during pregnancy and increases the risk of ASD (Schultz., 2010.).
CB2 receptors are important eCB receptors that detect and respond to levels of circulating cannabinoids. CB2 receptors have been found to be greatly upregulated (more abundant) in ASD patients (Siniscalco et al., 2013.) This is thought to be the body’s way of compensating for low levels (deficiency) of naturally occurring cannabinoids like anandamide.
- CB1 was not found to be upregulated
- CB2 may be a key therapeutic target for ASD treatment
- Generally requires small doses for symptom control
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TREATING AUTISM SPECTRUM DISORDER WITH CANNABIS
Dr. Bonni Goldstein is specializes in treating patients with cannabis in L.A. She has successfully treated thousands of adult and pediatric patients with cannabis. In her book Cannabis Revealed, she outlines her experience treating ASD, and dose recommendations:
“Most of the families that come to my office seeking cannabis treatment for their loved one with autism have tried multiple medications and interventions without success. Some of these patients respond to CBD-rich cannabis, some to THC-rich cannabis, and some to combination THC+CBD; more recently, I have seen a number of autism patients have unexpected significant improvement with THCA. I recommend starting with low dose sublingual drops as accurate dosing and titration is easiest with this method in the pediatric population (although some children may swallow the liquid if they cannot cooperate with holding the liquid under the tongue). Accurately tested edible products may work well. However, it is important that the parent of caregiver start with very low doses as THC-rich edibles produces can cause uncomfortable psychoactivity if the dose it too high.
In children I recommend starting CBD-rich or THCA-rich oil, and adding THC as needed to obtain desired effects. Many of these patients appear to have a high tolerance to the psychoactivity of THC. This may be due to an endocannabinoid deficiency/dysfunction or to less sensitivity in general, as children have immature cannabinoid receptors.” (Goldstein, 2017, pg. 146)
If you’re interested in reading more from Dr. Goldstein on treating ASD with marijuana, checkout her book Cannabis Revealed, on Amazon (2017 Book of the Year semi-finalist for the American Botanical Council).
Belmonte MK, Allen G, Beckel-Mitchener A, Boulanger LM, Carper RA, Webb SJ. Autism and abnormal development of brain connectivity. J Neuroscience 2004;24:9228-9231.
Chakrabarti B, Kent L, Suckling J, Bullmore E, Baron-Cohen S. Variations in the human cannabinoid receptor (CNR1) gene modulate striatal responses to happy faces. Eur J Neurosci 2006;23: 1944-1948.
Jaramillo TC, Liu S, Pettersen A, Birnbaum SG, Powell CM. Autism-related neuroligin-3 mutation alters social behavior and spatial learning. Autism Res 2014;7:264-272.
Schultz ST. Can autism be triggered by acetaminophen activation of the endocannabinoid system? Acta Neurobiol Exp (Wars) 2010;70:227-231.
Siniscalco D. et al., Cannabinoid receptor type 2, but not type 1, I s up-regulated in peripheral blood mononuclear cells of children affected by autistic disorders. J Autism Dev Disord. 2013 Nov;43(11):2686-95. doi: 10.1007/s10803-013-1824-9.
Goldstien, B. Cannabis Revealed How the World’s Most Misunderstood Plant is Healing Everything from Chronic Pain to Epilepsy. ISBN: 978-0-9981413-0-5