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EFFICACY, TOLERABILITY AND SAFETY OF CANNABIS OIL IN
CHILDREN WITH AUTISM: A LITERATURE REVIEW
Carolina Sousa Martins1
Wander Moreira Lopes2
Gustavo Vieira Dias3
Abstract: Autism Spectrum Disorder is a neurological condition that presents itself in diverse ways,
mainly affecting communication and behavior. Given the heterogeneity and particularity of each
case, the search for appropriate treatment still becomes a great challenge. In this scenario, the use
of Cannabis sativa oil has been noted as a potential alternative treatment. This literature review
study aims to assess the clinical experience with the use of full-spectrum Cannabis sativa oil, rich in
cannabidiol, in the treatment of people diagnosed with autism spectrum disorder. The objective of the
study was to investigate aspects of tolerability, safety and possible therapeutic effects, in addition to
highlighting the importance of individualized strategies in the management of this population. This
research is a narrative literature review with an integrative approach, with the objective of gathering,
analyzing and synthesizing scientic evidence related to the therapeutic use of cannabinoids, especially
cannabidiol and tetrahydrocannabinol, in patients diagnosed with Autism Spectrum Disorder. This
literature review allowed us to consolidate relevant evidence about the therapeutic potential of
cannabinoids, especially cannabidiol, as an adjuvant strategy in the management of the symptoms of
Autism Spectrum Disorder. The studies analyzed indicate that the use of cannabidiol can contribute
to the reduction of symptoms such as irritability, aggression, anxiety and sleep disorders, favoring the
adaptive behavior and quality of life of patients with autism spectrum disorder and their caregivers.
1 Centro Universitário de João Pessoa, João Pessoa, PB – Brasil
2 Centro Universitário de João Pessoa, João Pessoa, PB – Brasil
3 Centro Universitário de João Pessoa, João Pessoa, PB – Brasil
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Keywords: cannabidiol; autism spectrum disorder; alternative therapies.
Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by a
heterogeneous set of clinical manifestations, the severity of which can vary widely among affected
individuals. Key symptoms include persistent decits in communication and social interaction, as well
as restrictive, repetitive, and stereotyped patterns of behavior, interests, or activities (AMERICAN
PSYCHIATRIC ASSOCIATION, 2013; LORD et al., 2020). The global prevalence of ASD is estimated
to be approximately 1 in 100 children, making it one of the most prevalent chronic childhood disorders,
with a signicant impact on public health and educational and social systems (WORLD HEALTH
ORGANIZATION, 2023; FREIRE, 2023). Also, according to the most recent CDC data, from the
year 2025, the prevalence is estimated to be 1 in 31 children in the United States on the spectrum
(CENTERS FOR DISEASE CONTROL AND PREVENTION, 2025).
The etiology of ASD is multifactorial, involving complex interactions between genetic
predispositions, epigenetic and environmental factors, which are not yet completely understood
(GESCHWIND; STATE, 2015; LAI et al., 2014). To date, there is no specic and universally effective
pharmacological treatment for the disorder. Thus, clinical interventions focus on reducing disruptive
behaviors and promoting the childs global development, usually through combined therapeutic
approaches (ENGLER et al., 2024; HYMAN et al., 2020).
In recent years, there has been a considerable increase in scientic interest in the use
of cannabinoids as an adjunctive therapy in the management of ASD. Among these compounds,
cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) stand out, both present in the plant Cannabis
sativa. CBD, in particular, has been investigated for its anxiolytic, antipsychotic, anticonvulsant, and
behavior-modulating properties (GOMES, 2021; ARAN et al., 2019).
Recent studies suggest that the endocannabinoid system (ECS) may play a relevant role in
the pathophysiology of ASD, as it participates in the regulation of neurotransmitters such as serotonin,
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dopamine, and glutamate – all of which are implicated in the functions of cognition, synaptic plasticity,
social behavior, emotional response, and nociception (HOLDMAN, 2022; SILVA JÚNIOR, 2020;
ZOU; KUMAR, 2018). Changes in the functioning of the ECS have been observed in individuals
with ASD, which reinforces the hypothesis that its modulation may contribute to the improvement of
behavioral and emotional symptoms (FLETCHER et al., 2020; PEDRAZZI, 2022).
In this context, the present literature review study aims to investigate the clinical experience
with the use of Cannabis sativa CBD-rich, full-spectrum in the treatment of people diagnosed with
ASD. The objective of the review was to study aspects of tolerability, safety, and possible therapeutic
effects, in addition to emphasizing the importance of individualized strategies in the management of
this population.
Methodology
The present research is a literature review of the narrative type with an integrative approach,
with the objective of gathering, analyzing and synthesizing scientic evidence related to the
therapeutic use of cannabinoids, especially cannabidiol (CBD) and tetrahydrocannabinol (THC), in
patients diagnosed with Autism Spectrum Disorder (ASD). The integrative review, as proposed by
Whittemore and Kna (2005), allows the inclusion of studies with different methodological designs,
promoting a comprehensive and critical understanding of the phenomenon investigated.
The elaboration of the review followed systematic methodological steps, namely: denition
of the guiding question, establishment of inclusion and exclusion criteria, selection of databases,
denition of search strategies, selection of studies, extraction and categorization of data and,
nally, critical analysis and synthesis of the results. The guiding question was built based on the
PICO (Population, Intervention, Comparison and Outcome) strategy, as follows: P – patients with
Autism Spectrum Disorder; I – use of cannabinoids (CBD and/or THC); C – comparison with other
therapeutic interventions or placebo (when applicable); and O – clinical and behavioral effects, safety
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and tolerability. Thus, the central question of this review was: what are the therapeutic effects, risks
and benets of using cannabinoids in the treatment of Autism Spectrum Disorder?
The searches were carried out in the PubMed/MEDLINE, Scopus, Web of Science, Embase,
ScienceDirect, SciELO and Virtual Health Library (VHL) databases, as they are widely recognized
in the health area and offer international coverage. Articles published between January 2015 and April
2025, in Portuguese, English, and Spanish, were considered. The choice of this time frame is justied
by the exponential growth of clinical research on medicinal cannabinoids over the last decade.
Original studies with different designs (clinical trials, observational studies, and systematic
reviews with or without meta-analysis) were included, as long as they addressed the use of cannabinoids
in individuals diagnosed with ASD and presented data on efcacy, safety, tolerability, or adverse
events. Opinion articles, editorials, letters to the editor, abstracts of scientic events, and studies
whose focus was not directly related to the central theme were excluded, as well as those that presented
only data with animal models, except when these contributed signicantly to the understanding of the
pathophysiology of the disorder and its relationship with the endocannabinoid system.
The search strategies were adapted to each database consulted, using combinations between
controlled descriptors (DeCS/MeSH) and free keywords. An example of the strategy used in PubMed
was: (Autism Spectrum Disorder” OR “ASD” OR “Autistic Disorder” OR “Autism Spectrum
Disorder”) AND (“Cannabis” OR “Cannabidiol” OR “CBD” OR “THC” OR “Medical Cannabis
OR “Cannabinoids”) AND (“Treatment” OR “Therapy” OR “Intervention”). The selection of articles
was carried out in two stages: initially, through the reading of titles and abstracts, followed by the full
reading of the eligible texts and le. Two reviewers performed this screening independently and, in
case of disagreement, a third reviewer was consulted for a consensual decision. The selection process
followed the recommendations of the PRISMA model (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses).
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Chart 1 – Methodological Stages of Integrative Review.
Stage Description
1. Denition of the guiding question Based on the PICO strategy, aiming to identify the therapeutic
effects of cannabinoids on ASD
2. Establishment of inclusion/exclusion criteria Dened the types of studies, language, period and target population
3. Selection of databases PubMed, Scopus, Web of Science, Embase, ScienceDirect,
SciELO and VHL
4. Search strategy Use of controlled descriptors (DeCS/MeSH) and free keywords
adapted to each database
5. Selection of studies Reading of titles, abstracts and full texts by two independent
reviewers; Consensus with third reviewer
6. Data extraction and categorization Organization of data in a spreadsheet with predened categories
7. Analysis and synthesis of results Qualitative and descriptive analysis of the ndings and
identication of convergences/gaps
Source: Survey data, 2025.
The extracted data were organized in a spreadsheet containing the following categories:
author and year of publication, country of origin of the study, type of methodological design, sample
characteristics (age, gender, diagnosis), type of cannabinoid used (CBD, THC, or both), route of
administration and dose, clinical outcomes evaluated (such as behavior, social interaction, cognition,
sleep), observed adverse events, and authors’ conclusions.
Chart 2: Inclusion and Exclusion Criteria.
Source: Survey data, 2025.
Inclusion Criteria Exclusion Criteria
Articles published between 2015 and 2025 Studies focusing outside of ASD and cannabinoids
Languages: Portuguese, English and Spanish Opinion pieces, editorials, letters, event summaries
Human studies (and animal models only where relevant) Studies exclusively with animal models with no direct
relevance
Clinical trials, observational, systematic reviews Studies without data on efcacy, safety, or tolerability
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Data analysis was conducted in a qualitative and descriptive manner, allowing a critical
comparison between the ndings and the identication of gaps and convergences in the literature.
Results and Discussion
ASD It is a multifactorial genetic neurodevelopmental disorder, characterized by persistent
decits in communication and social interaction, as well as the presence of repetitive, restricted, and
stereotyped patterns of behavior, interests, or activities. Individuals with the disorder may present both
verbal and non-verbal difculties, such as atypical use of language, echolalia (immediate or delayed
repetition of words or phrases heard), as well as difculty in initiating or sustaining conversations and
inadequate variation in tone or intonation (APA, 2013).
In relation to social interaction, there is a clear impairment in emotional and social reciprocity:
many individuals have difculty sharing interests or emotions with other people, maintaining direct
eye contact since early childhood, and showing little interest in everyday social interactions, which can
also be observed through techniques such as eye tracking, which reveal altered patterns of attention to
the gaze of others (Jones et al., 2018; APA, 2013). In addition, repetitive patterns include stereotyped
behaviors (such as repeated motor movements), rigidity in routines, resistance to change, intense and
circumscribed interests, and sensory hyper- or hyporeactivity, such as extreme sensitivity to specic
textures, sounds, or smells (APA, 2013; Lázaro & Pondé, 2017).
These symptoms vary widely in severity, requiring different levels of clinical and therapeutic
support. The diagnosis it is done in a clinical and multidisciplinary way, based on detailed anamnesis
and behavioral evaluation, since there are no laboratory or imaging tests capable of conrming it
(Gomes et al., 2015). As already reported, the global prevalence of ASD is 1 in 100 children, which
proportionally represents the level of concern in the eld of public health (World Health Organization,
2023; Freire, 2023).
The analysis of the selected studies revealed a signicant growth in scientic production
Level Features Intervenção
Level 1: Minimal support needed Difculty communicating, although
not limiting social interactions;
does not present many associated
comorbidities.
Cognitive-behavioral therapy;
Social skills training; Educational
interventions.
Level 2: Moderate need for support Apparent difculty with language
and conversation; atypical social
behavior; cognitive rigidity; difculty
dealing with change and hyperfocus.
Applied behavior analysis (ABA);
Occupational therapy; Speech
therapy; Support
Level 3: Greater need for support Signicant decit in communication
skills, both verbal and non-verbal;
signicant difculty in social
interaction with a tendency towards
isolation; reduced cognition and
intellectual disability; serious
difculties in dealing with change.
Intensive ABA intervention; Speech
therapy; Medical support and
complementary therapies; Specic
care.
Caption: ASD - autism spectrum disorder
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related to the therapeutic use of cannabinoids in individuals with Autism Spectrum Disorder
(ASD), especially from 2015 onwards. After the initial screening of 264 articles, 38 studies met the
inclusion criteria and were fully analysed. Among these, 17 were clinical trials (randomized or not),
12 observational studies, 5 systematic reviews (with or without meta-analysis), and 4 translational
studies that addressed pathophysiological aspects related to the endocannabinoid system (ECS).
Chart 3: ASD levels and their intervention needs
Most of the studies were conducted in countries with more permissive regulations for the
medicinal use of cannabis, such as Israel, Canada, the United States, and some European countries.
The age range of the patients ranged from 3 to 40 years, with a predominance of studies focused on
children and adolescents (70%). The samples mostly included individuals with a conrmed diagnosis
of ASD according to DSM-5 or ICD-11 criteria.
Level Features Intervenção
Level 1: Minimal support needed Difculty communicating, although
not limiting social interactions;
does not present many associated
comorbidities.
Cognitive-behavioral therapy;
Social skills training; Educational
interventions.
Level 2: Moderate need for support Apparent difculty with language
and conversation; atypical social
behavior; cognitive rigidity; difculty
dealing with change and hyperfocus.
Applied behavior analysis (ABA);
Occupational therapy; Speech
therapy; Support
Level 3: Greater need for support Signicant decit in communication
skills, both verbal and non-verbal;
signicant difculty in social
interaction with a tendency towards
isolation; reduced cognition and
intellectual disability; serious
difculties in dealing with change.
Intensive ABA intervention; Speech
therapy; Medical support and
complementary therapies; Specic
care.
Caption: ASD - autism spectrum disorder
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Table 4 – Summary of Included Studies
Author/Year Study Type Population Intervention Main results
Aran et al. (2018) Retrospective study 60 children with
ASD
Oral CBD in adjusted
dose per kg
Signicant reduction
in aggression and self-
stimulatory behaviors.
Barchel et al. (2019) Observational study 53 children CBD + THC oil Improved social
behaviors and reduced
anxiety.
Fleury-Teixeira et al.
(2019)
Pilot clinical trial 15 patients CBD 50100 mg/day Reduction of
hyperactivity and
improvement of sleep.
Ifand &
Grotenhermen
(2017)
Systematic review Clinical and
preclinical studies
Various doses of
CBD
Good tolerability and
few adverse effects
reported.
Holdman (2022) Narrative review Human and animal
studies
CBD and
relationship with
endocannabinoid
system
Hypothesis of ECS
dysfunction in ASD;
rationale for cannabinoid
therapies.
Pavlovic et al. (2022) Systematic review 11 studies reviewed CBD, SEC and
autism
Relationship between
ECS alteration
and typical autism
behaviors.
Pretzsch et al. (2019) Randomized
crossover clinical
trial
Adults with and
without ASD
Single dose of 600
mg of CBD
Signicant changes in
GABA and glutamate
levels in patients with
ASD.
Masataka (2019) Study in animal
model (murine)
Mice with ASD
phenotype
CBD in different
doses
Reduction of social
avoidance behaviors.
Silva Júnior (2020) Integrative review Human studies CBD interventions Preliminary evidence
of benet in behavioral
symptoms of autism.
Engler et al. (2024) Critical review 2018–2023 clinical
studies
CBD/THC Emphasis on the
importance of
standardized protocols
and individualized
management.
Zamberletti et al.
(2021)
Preclinical study
with rats
Mice with ASD
induction
Cannabidivarin
(CBDV)
Reduction of
stereotypies and
improvement of social
interaction.
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Dos Santos et al.
(2023)
Systematic review Studies with ASD Cannabinoids in
general
Promising efcacy, but
need for more clinical
trials.
Gomes (2021) Literature review Scientic and legal
literature
Medical cannabidiol It points to legal and
therapeutic advances in
Brazil.
Pedrazzi (2022) Narrative review Physiological-based
studies
ECS and
neurotransmitters
Association of the
ECS with cognition,
plasticity and socio-
emotional responses in
ASD.
Freire (2023) Descriptive study Brazilian casuistry
in ASD
Not applicable It reinforces the social
impact of ASD and the
urgency of therapeutic
alternatives.
Source: Survey data, 2025.
Cannabidiol (CBD) was the main compound investigated, either alone or in full-spectrum
oil formulations with varying proportions of tetrahydrocannabinol (THC). The average dose of CBD
used ranged from 10 to 600 mg/day, and is generally adjusted according to body weight. Studies
such as the one by Aran et al. (2018) have reported clinical benets with formulations containing
CBD:THC in a 20:1 ratio, showing improvement in symptoms such as hyperactivity, sleep disorders,
and self-injurious behaviors.
Most studies have observed moderate to signicant positive effects in reducing core
symptoms of ASD. Aran et al. (2019), in a prospective study with 60 children, demonstrated that 61%
of participants showed signicant improvement in aggression crises, 47% in anxious behaviors, and
39% in communication and social interaction after 6 months of CBD use. Barchel et al. (2019), in a
cohort of 188 patients, reported a reduction in episodes of self-mutilation and improved sleep in 71.4%
of cases.
In the randomized study by Pretzsch et al. (2019), it was observed that CBD promoted
functional changes in the pre-cortex-frontal and amygdala, areas involved in emotional and social
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regulation, with improved empathy responses and facial expression recognition.
Systematic reviews such as that by Pavlovic et al. (2022) have reinforced that cannabinoids
have the potential to modulate the endocannabinoid system, inuencing the release of neurotransmitters
such as serotonin, dopamine, and glutamate, which are often dysregulated in individuals with ASD
(Zamberletti et al., 2021).
While therapeutic effects were highlighted, safety and tolerability were also analyzed. In
general, the most commonly reported adverse effects included drowsiness, diarrhea, mild irritability,
and changes in appetite (Aran et al., 2020; Fleury-Teixeira et al., 2019). Most events were classied as
mild to moderate and resolved with dose adjustment.
It is important to note that adverse effects were signicantly more frequent in formulations
with THC above 0.3%, reinforcing the need for strict clinical monitoring and individualization of
treatment (Masataka, 2019). No serious adverse events directly associated with the use of CBD at the
proposed therapeutic doses were identied.
Despite the promising results, the available studies have signicant methodological
limitations, such as small sample sizes, absence of control groups, short duration of follow-up, and
wide heterogeneity in designs, ranging from case studies to controlled clinical trials. There is also
considerable variation in formulations (such as CBD alone versus full-spectrum), dosages, and methods
of assessing clinical outcomes, which makes it difcult to generalize ndings. Given this scenario,
authors such as Dos Santos et al. (2023), Elms et al. (2019), and Whiting et al. (2015) highlight the need
for large-scale randomized clinical trials, with product standardization and more rigorous protocols,
in order to obtain robust evidence on the efcacy and safety of the treatment.
The results of this review highlight the growing attention devoted to the use of
phytocannabinoids, especially cannabidiol (CBD), as an adjuvant therapy in the management of
Autism Spectrum Disorder (ASD). As shown in the table of included studies, most investigations
have positive effects related to the reduction of behavioral symptoms, such as anxiety, aggressiveness,
and episodes of self-injury, corroborating previous ndings by authors such as Barchel et al. (2019)
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and Aran et al. (2020), who observed a signicant improvement in the quality of life of patients and
their families.
In addition, some studies have reported mild to moderate adverse effects, such as fatigue,
irritability, and gastrointestinal changes, but no serious events have been documented, suggesting a
relatively favorable safety prole (Fleury-Teixeira et al., 2021; Bar-Lev Schleider et al., 2019). However,
the scarcity of longitudinal studies prevents the evaluation of potential long-term effects, an issue that
should be a priority in future research.
The association between the endocannabinoid system and the pathophysiology of ASD,
suggested by Pedrazzi (2022) and Holdman (2022), is supported by the reviewed studies, which indicate
the modulation of neurotransmitters as a plausible mechanism for the therapeutic effects of CBD.
This perspective opens new frontiers for less invasive and potentially more effective pharmacological
interventions in the treatment of the central and associated symptoms of ASD.
Finally, the ndings reinforce the importance of individualized management, since the
response to cannabinoid treatment presents interindividual variability, probably inuenced by genetic
and environmental factors, and the complexity of the autism spectrum (Gomes, 2021; Engler et al.,
2024). It is therefore recommended that future research include genetic analyses and biomarkers that
can predict the therapeutic response, consolidating personalized medicine in this area.
Conclusion
The present literature review allowed us to consolidate relevant evidence about the therapeutic
potential of cannabinoids, especially cannabidiol (CBD), as an adjuvant strategy in the management of
the symptoms of Autism Spectrum Disorder (ASD). The studies analyzed indicate that the use of CBD
can contribute to the reduction of symptoms such as irritability, aggressiveness, anxiety, and sleep
disorders, favoring adaptive behavior and quality of life for patients with ASD and their caregivers.
The action of cannabinoids on the endocannabinoid system (ECS), which is related to the
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modulation of neurotransmitters such as dopamine, serotonin, and glutamate, provides a plausible
physiological basis for their benecial effects. However, still It is necessary to advance in research
that uses more robust methodological designs, such as randomized and controlled clinical trials, with
larger samples, standardization of doses and formulations used.
It is also evident the need for well-dened clinical protocols and the training of qualied
professionals to ensure a safe and individualized use of Cannabis sativa derivatives in therapeutic
contexts. Adequate regulation and quality control of products are essential to make this therapeutic
proposal feasible within evidence-based medical practice.
Thus, it is concluded that, despite the promising advances, the use of CBD in the treatment of
ASD should still be considered experimental, with promising therapeutic potential, but which requires
more scientic evidence to support its efcacy and safety in a broad and standardized way.
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