Parents of children with ASD often struggle in an endless search for treatment modalities to alleviate severe symptoms such as aggression, self-harm, restlessness, sleep problems, hyperactivity, anxiety, and other comorbidities. Conventional medical treatment includes various psychotropic medications such as atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), stimulants, and anxiolytics.2 However, use of these medications for ASD is often not effective and is commonly associated with adverse drug reactions.

Cannabidiol is a cannabis derivative that exhibits no addictive and neuropsychiatric properties. Hence, it is the preferred product for use in children, and, at the initiation of their parents and with support from their physicians, increasing numbers of ASD children are receiving approval for cannabis products to combat autistic symptomatology.

In this observational retrospective study our team reviewed children diagnosed with ASD and receiving their cannabis from Tikun Olam Ltd (Tel Aviv, Israel) (see below). They were administered oral oil-based cannabinoid extract drops, after permission was granted by the Israeli Ministry of Health for administration under the supervision of the children’s pediatricians. For the purpose of this retrospective review, the Shamir Hospital Research ethics committee approved an anonymous retrospective review of the patients’ charts.

The cannabinoid oil solution used was prepared by Tikun Olam Ltd (Tel Aviv, Israel) at a concentration of 30% and at 1/20 ratio of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC). During the first meeting, parents were instructed by a nurse practitioner on how to administer the preparation. Thereafter, a biweekly follow-up telephone interview was conducted, where parents reported on effects and adverse effects of the cannabis given to their children and issues of efficacy and safety were discussed. Typically, therapy started with one or two drops given under the tongue, with the dose increased or decreased based on the child’s reported response.

Fifty-three children at a median age of 11 (range 4–22) years received cannabis and were followed up for changes in ASD-related symptoms.3 Median treatment duration was 66 days (range 30–588); median daily CBD and THC doses were 90 mg (range 1.5–315) and 6.75 mg (range 0.5–49.5) mg, respectively. The parents reported a notable improvement in self-injury and rage attacks, hyperactivity, sleep problems, anxiety and mood problems, and social communication and reciprocity issues (Table 1).

When parents (51 out of 53) were asked to evaluate the overall change in their children’s ASD symptoms, significant improvement was reported in 43.1%, mild to moderate improvement was reported in 31.4%, and no change was reported in 21.6%; in the case of 2 children (3.9%), parents reported a worsening of symptoms. The most common reported adverse effects were somnolence, nausea, and change in appetite.

These results are consistent with other preliminary reports of the effectiveness of cannabis in ASD.4,5 Hence, based on the parents’ reported outcomes, this study suggests that cannabidiol may be effective in improving ASD comorbidities symptoms, with few and transient adverse effects. However, the long-term effects and safety of these preparations should be evaluated in further large-scale, controlled studies.