as presented by Tracy Fritz, M.D. at the AutismOne Conf. on May 26

Anecdotal evidence of the positive effects of cannabidiol (CBD) in children with autism has been increasingly reported over the last several years in the autism community. A growing body of scientific research continues to explore the body’s endocannabinoid system (ECS) and its potential for neurological and immunological dysfunction which is commonly seen in children with autism spectrum disorder (ASD) and related disorders.

Supplementation of plant-based cannabinoids, such as CBD, has been noted to have positive effects on brain and immune function in a variety of neuro-immunological disorders. I have used CBD in a clinical setting to treat common behavioral symptoms observed in ASD and PANS (pediatric acute neuropsychiatric syndrome). Symptoms amenable to treatment with CBD include, among others, sleep disturbance, anxiety/OCD, impulsivity, stimulatory behavior, nausea, emetophobia, and feeding problems.

I practice medicine in Missouri where medicinal cannabis has not been legalized. So the CBD-based products I use are hemp derived, and because the Food & Drug Administration has approved CBD as a nutritional supplement, it is legally available to be shipped to all 50 states.

When treating autistic patients and those with PANS, the symptoms that I see most often are repetitive and self-injurious behaviors, sleep dysfunction, hyperactivity, ADHD, mood disturbances, anxiety, depression, OCD, aggression, rage, appetite disturbances such as anorexia, nausea, and fear of vomiting or emetophobia.

Phytocannabinoids or CBD oil is a viable intervention, specifically for mood or behavior disturbances that are difficult to treat. This is especially true because there are limitations to the pharmaceuticals that physicians are able to prescribe in an effort to try to get symptom control for children with ASD.

A child with PANS or autism often experiences very negative effects from medicines that may be successful for people who don’t have PANS or ASD because their blood-brain barrier is more or less intact and there’s a projectable way they metabolize and respond to the medicine.

A child who begins a normal starting dose of Sertraline or Zoloft can get acutely worse. They can get aggressive, their motor ticks and mood symptoms can get worse, and they can get psychotic. The same thing happens when using stimulants to control ADHD symptoms, children often have a rapid worsening of their psychiatric state. So in patients who are having behavioral and neurologic problems, the medicine physicians are comfortable giving don’t have the predictable response we are use to and can often worsen symptoms that we are trying to help.

An alternative like CBD is viable because it has an excellent safety record, it’s well tolerated by patients of all ages, and it can be titrated up to an effective dose. You can start with a low dose, monitor the patient closely for clinical effects, and increase the dose to find their sweet spot.

When selecting a CBD product, you want to use a quality product so make sure to get lab testing information from the dispensary or manufacturer. You want to make sure it’s a clean product, absent of heavy metals and pesticides.

There are different forms CBD comes in. I prefer the liquid form in an oil that is administered via sprays or squirts. Cannabinoids are extracted from the plant and added to coconut oil and because it’s a lipid molecule that helps with absorption into the body. It’s also available in a paste form which is more concentrated so I reserve that for a patient who is at a dose that is effective and I know they are going to stay at that dose. The recommended dose is the size of a rice grain and that’s a measured dose. Capsules are also an option which is another form to use.

Typically I will start a patient on 3 milligrams which is two squirts of CBD. It tends to work best if you do it at bedtime. It does have very minimal side effects. At the beginning some people do feel a little tired and spacey but that is short-lived. Bedtime is a good time to dose because the brain and the immune system do a lot of their balancing when you are in a nice deep sleep.

Typically I increase the dose by 3 milligrams weekly. Of course, everybody is different and it varies by each individual patient, but for the most part smaller patients take between 12 to 24 milligrams. Doses up to 700 milligrams a day have been studied and found to be perfectly safe.

It’s important to note that because the endocannabinoid system is a balancing system and you are trying to restore homeostasis, more is not always better. You don’t want to overwhelm a system that is trying to accomplish balance so start low and slow and don’t be in a hurry to increase it.

CASE #1: I treated a nine-year-old girl with regressive autism who was diagnosed at age three. At age seven, after a strep throat infection, she developed PANS. She started on 1.5 milligrams of CBD and I increased it every couple of weeks which she tolerated very well to a dose of 6 milligrams. Of course, we were doing a lot of other things for her, but when we added CBD oil to her treatment her nighttime fears and anxiety decreased markedly.

CASE #2: A six-year-old boy named AW who had a diagnosis of Asperger’s had a regression after a vaccination at age five with a sudden onset of acute neuropsychiatric symptoms. When I first started seeing him, he had lost 10 lbs. from the onset of nausea, anorexia and emetophobia. We started him on CBD oil and it helped him quite a bit. We dosed him once a day at bedtime. Because he would fall apart about midday, I started dosing him twice a day which worked well for him. He gained back the 10 lbs. he lost and has since gained another 12 lbs. and is happy and doing well.

CASE #3: This patient had a regression into very severe autism as a toddler after a vaccine. She had used biomeds for 15 years and then she had an acute change in her status at 18 years old. She had a manageable life and then overnight it became unmanageable and she had the onset of anxiety and sleep disturbance along with some other neuropsychiatric symptoms. She had severe anorexia and a 22-lb. weight loss when I started seeing her. I immediately started her on CBD oil and titrated her up more quickly by giving her doses of 25 milligrams twice a day. She had a positive clinical response after five to six weeks of therapy. It took a while to have a positive effect, but she finally began to sleep. Once we got a good sleep cycle maintained for her, she started to improve in other areas with therapy.


Dr. Tracy Fritz is cofounder of Little Flower Center for Integrative Medicine in St. Louis, Missouri. She provides specialized care to patient populations, including children with autism spectrum and related disorders. Dr. Fritz received her MD from Tufts University School of Medicine, completed her residency in family medicine at Naval Hospital Pensacola, and is a fellow in the Medical Academy
of Pediatric Special Needs (MAPS).