Priscilla Batista is stuck at home in Charlotte, N.C., with a highly emotional 4-year-old.“Every toddler obviously is emotional, but she’s a pretty constant, volatile child,” she said. “It doesn’t allow her to focus. She’s just struggling.” Batista doesn’t yet have an official diagnosis for her daughter, but, suspecting an attention deficit disorder, she has turned to CBD (cannabidiol) for help.
CBD is one of the more well-known components of cannabis, along with THC (tetrahydrocannabinol). Both chemicals affect the brain, but while THC makes users feel high, CBD doesn’t, though it does make some users feel more relaxed. CBD products have become hugely popular around the world, from oils that can be eaten or rubbed on skin, to soaps, gummy candies and even pet treats.
A 2019 Gallup poll found 14 percent of more than 2,500 Americans surveyed use CBD products, mostly for pain, anxiety and sleep problems. Statistics for kids are much harder to come by, but there are Facebook groups with thousands of followers where parents discuss giving CBD to their kids for conditions including the autism spectrum and attention deficit hyperactivity disorder. In April, a cannabis-focused magazine published a survey of more than 500 parents and found that 40 percent had given CBD products to their children for behaviors related to the autism spectrum.
Very little controlled research has been done with CBD and kids. There is only one approved drug based on CBD for any age group, and that’s for rare kinds of epilepsy in children. There are promising hints — but little proof thus far — that the compound might work on some other conditions in children too, including other kinds of seizures, autism and anxiety.
“When you’re desperate, you want options,” said John Mitchell, clinician at Duke ADHD Clinic in Durham, N.C. “I’m a parent myself. I get it.” But, he cautioned, for now the enthusiasm is running ahead of the science. “I’m very hesitant to say anything promising about it. It’s an open question.”
The medical community considers pure CBD relatively safe: The World Health Organization, for example, has said there’s no evidence of anyone abusing CBD recreationally, or of any public health problems. But there are still some risks, especially for kids.
Last year, the Food and Drug Administration wrote that CBD has the potential to cause liver injury (in users of any age), and suggested it might affect the developing brains of children. No one knows the long-term effects of giving CBD to kids, said Arno Hazekamp, Ph.D., a pharmaceutical researcher and cannabis consultant in the Netherlands. “Those kids are still kids,” he said. Researchers will have to wait until they are older to assess long-term effects. Also, since most CBD products aren’t regulated, he added, they can be tainted with dangerous additives.
Hints of help
The only drug containing CBD that has been approved for adults or children is Epidiolex, which is currently the only known treatment for two rare and devastating forms of childhood epilepsy: Dravet syndrome and Lennox-Gastaut syndrome. Epidiolex, approved in 2018, was developed after the high-profile case of Charlotte Figi, whose desperate mother used CBD to dramatically control her debilitating seizures.
The way that CBD acts on the brain makes it a good candidate for controlling seizures caused by other conditions too. The Epilepsy Foundation said that early evidence from animal studies, anecdotal reports and small clinical trials suggest that CBD could potentially help with seizures. Dozens of trials are underway to test if, why and how CBD might work for kids and adults suffering from seizures of various kinds.
There are also hints CBD might work for some autistic kids. Dr. Gal Meiri, M.D., clinical director of the National Autism Research Center of Israel at Ben Gurion University of the Negev, has studied CBD oils and autism. In a study that Meiri co-authored in 2019, 155 autistic kids aged 18 years and younger tried CBD oil for at least six months. More than 80 percent of the parents reported significant or moderate improvement in their kids. “Some of the parents reported benefits not just with seizures but also behaviors, like self-harm,” he noted.
Most such studies are based on parents’ perceptions, rather than measured changes in comparison to placebo groups. The placebo effect can be strong, since parents typically want to see improvements. A placebo-controlled trial of CBD for autistic children has been completed at the Shaare Zedek Medical Center in Israel, but the results aren’t yet published. Another is underway at the University of California, San Diego.
“I’m trying to be very cautious about it,” said Meiri with regards to CBD and autism. “We still don’t have enough research about safety and efficacy.”
Similarly, many parents are trying CBD products for children with A.D.H.D., for which there are no reported controlled trials with kids. One small trial on 30 adults with a mouth spray containing both CBD and THC had inconclusive results.
With no scientific proof that CBD works and is safe for children, Mitchell said stimulant-based medications like Adderall are a better option than CBD. “We know much more about one than the other, so the choice is simple,” he said. But he understands why a parent might consider CBD as an alternative, he said, given that it is typically seen as a gentle drug with few side effects.
That matches Batista’s experience. “My daughter has a beautiful personality; she’s sweet, she’s spunky. I don’t want to medicate her with something that’s going to turn her into a zombie,” she said, referring to parent complaints that some stimulant-based drugs can make their kids seem spacey.
“I don’t want her to fall behind,” she said. Batista has seen other kids with A.D.H.D. struggle academically. “It can really swallow a kid whole; then you have a failure to launch.”
Mitchell added there are signs CBD might help with anxiety: a symptom that sometimes accompanies autism and A.D.H.D. In a 2018 study of CBD for kids with autism, for example, anxiety improved in more than a third of the 60 patients.
Surprisingly, there’s not much evidence that CBD helps with sleep — despite its reputation for causing drowsiness in recreational users. “Something can make you sleepy and have no effect on your sleep quality,” said Hazekamp.
No silver bullets
Even if CBD is someday approved for use against other kinds of seizures, autism or A.D.H.D., it is unlikely to work for everyone.
Kelly Cervantes, a mother and health activist in Chicago, gave CBD to her daughter Adelaide, who suffered from an unidentified neurodegenerative condition with severe infantile spasms. “We were desperate, and we wanted to try anything we could,” said Cervantes. That was when her daughter was about a year and a half old, and before Epidiolex, so she says she got the product online rather than though her doctor. Sadly, Adelaide’s symptoms got worse. “It entirely depends on the child. There is no one pill, one oil, one treatment that is going to cure everyone,” she said.
In addition, Adelaide’s doctors began to see signs of liver failure. Cervantes took her off the CBD. She said CBD, “does not come without side effects, which I think is a major misconception about it.” In trials of Epidiolex, a moderate dose caused side effects in at least 10 percent of the children, including elevated liver enzymes, decreased appetite, diarrhea, fatigue, sleep problems and malaise.
Furthermore, it’s impossible to know what’s in a CBD product without independent testing. One of Hazekamp’s studies in the Netherlands analyzed 46 cannabis oils made by patients or sold online. Only 21 products even advertised the ingredient concentrations and many of those were wildly wrong. Seven didn’t contain any cannabinoids at all. One of them had more than 50 percent more THC in it than the product claimed.
“There can be pesticides, heavy metals and microbes in the plants,” said Hazekamp. It isn’t clear if those are making it into CBD oils, he said.
It’s impossible to overdose on pure CBD, but synthetic knock-offs can be poisonous. In 2019, the American Association of Poison Control Centers put out an alert noting “growing concern” about CBD products, with national calls about CBD rocketing from just over 100 in 2017 to more than 1,500 last year.
“The labels aren’t always right,” said Hazekamp. “If you try it, make sure it is what you think it is.”
Talk to your doctor
When Cervantes tried CBD, she bought it online from what she believed to be a reputable company, but she can’t be sure what was in it. It would help parents of suffering children, she said, if CBD products were more regulated and parents felt they could talk to their doctors about it, rather than worrying about its association with marijuana.
“I had a patient start taking CBD and I only found out a month in,” said Mitchell. “Parents may assume that a doctor will respond in a negative way.” It’s a doctor’s responsibility, he said, to be open to discussing options. “If you shut a patient down, it doesn’t mean you won the argument, it means they’re not going to talk about it.”
Batista said her daughter’s doctors told her to be careful with CBD and didn’t recommend it.
Still, she’s been using it for several months, getting it from a company that advertises independent testing to confirm their product’s contents, and starting with a low dose. She said she can’t tell if it’s doing anything, but holds out hope that a gentle drug with few side effects will be effective for her little girl. “I want to think that it’s helping.”
Nicola Jones is a science writer based in British Columbia, Canada.