Is it Safe to Give a Child CBD for ADHD?
In this Article
- What is CBD?
- Does CBD Help ADHD?
- Is CBD Safe for Children?
CBD, or cannabidiol, is gaining widespread popularity. A 2019 Gallup poll found that 14% of Americans use CBD for issues such as sleep, anxiety, and pain. A medicine that contains CBD, Epidiolex, is used in children with a certain kind of epilepsy. CBD is being promoted as an alternative treatment for ADHD. You may be wondering if it’s a safe and effective treatment for your child with ADHD.В
What is CBD?
CBD is a component of cannabis and medical marijuana, but it’s derived from the hemp plant, a cousin of the marijuana plant. CBD by itself won’t get you high. It doesn’t contain THC, which is the chemical in marijuana that causes you to get high.В
CBD products are available in a wide variety of products, including oil, gummies, vaping, and lotion. Because marijuana and cannabis products have been illegal in the US since 1970, there haven’t been many studies done on them. CBD derived from hemp is now federally legal. However, CBD derived from marijuana is still federally illegal. В
Does CBD Help ADHD?
The research into whether CBD helps ADHD is very limited. Most of the available research has focused on cannabis products that also contain THC.В
A small study in 2017 found that adults treated with Sativex, which contains CBD and THC, experienced a small reduction in ADD symptoms with no cognitive impairment. However, the improvement was not significantly better than the improvement with placebo.В
Another study that was done in 2020 found that adults who took higher doses of medical cannabis took fewer ADHD medicines and reported lower ADHD scores.
There is no scientific proof that CBD works or is safe for children. Until there is some proof that CBD is safe or effective to treat ADD, stimulant medicines such as Adderall are still a better option. There is some evidence that CBD oil may help with anxiety, which some kids with ADHD also have. A 2018 study done on 60 children with autism showed that anxiety improved in 39% of the children.
Is CBD Safe for Children?
There is no evidence that the CBD products on the market are safe or effective for children. The FDA has only approved one CBD product, a prescription drug called Epidiolex that treats seizures associated with certain types of epilepsy in patients older than 1. Epidiolex has been studied in clinical trials. While it has proven to be effective at reducing seizures, it has shown significant risks and side effects including:
- Elevated liver enzymes
- Decreased appetite
- Sleep problems
- Increase in suicidal thoughts
- Interference in how other medicines including propofol, bupropion, morphine, clobazam, lorazepam, and phenytoin work
The long-term effects of CBD are not known. CBD oil has not been studied adequately in clinical trials for problems such as ADHD. The American Academy of Pediatricians of Pediatrics does not support any use of medical marijuana products that haven’t been approved by the FDA. В
Problems with Unproven Medical Claims
Any CBD products other than Epidiolex making medical claims have not been evaluated by the FDA. They have also not been evaluated to determine the proper dose or for any dangerous side effects or other safety concerns. The FDA has tested the chemical of CBD in some products and found that they did not contain the amount of CBD in which they claimed.В
Other Safety Concerns
In addition to possible side effects and unproven medical claims, there are some other safety concerns with CBD oil including:В
- Products deliver an unreliable amount of CBD. There is no way to know how much you’re getting.
- There is no way to know how much is absorbed. Different delivery methods such as vaping, taking it orally, and eating it have different rates of absorption.В
- Products contain other ingredients that may not be safe.В
- There is no way to know what dose to give your child.В
Child Mind Institute: “CBD: What Parents Need to Know.”
Contemporary Pediatrics: “Examining cannabidiol use in children.”
European Neuropsychopharmacology: “Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial.”
Gallup: “14% of Americans Say They Use CBD Products.”
Harvard Health Publishing: “Cannabidiol (CBD) вЂ” what we know and what we donвЂ™t.”
Pediatrics Northwest: “Medical Use of Cannabis and CBD in Children.”
Rambam Maimonides Medical Journal: “Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients.”
Scientific Reports: “Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy.”
US Food and Drug Administration: “What You Need to Know (And What WeвЂ™re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD.”
Learn if itвЂ™s proven safe to give CBD to your child with ADHD, along with common concerns about it.
Should You Give Your Kid CBD?
More Americans are using the hemp (or marijuana) extract on their kids, but experts aren’t sold on its efficacy.
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.
More Americans are using the hemp (or marijuana) extract on their kids, but experts aren’t sold on its efficacy.