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EV0186

Cannabidiol in the treatment of core symptoms of autism spectrum disorder: a systematic review

CANNABIDIOL FOR THE TREATMENT OF CORE SYMPTOMS OF AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW

In a review of five studies involving 294 participants, cannabidiol was associated with mild to moderate improvement in 66% of patients, particularly in social communication.

The aim was to review the available evidence on the use of cannabidiol (CBD) for the core symptoms of autism spectrum disorder (ASD). The systematic review covered Scopus and PubMed from January 2021 to December 2025; eligible studies were clinical studies conducted in humans, published in English or Spanish, with a CBD:THC ratio of at least 20:1, and assessing core ASD symptoms as outcomes. Of the 138 records identified (Scopus n = 80, PubMed n = 58), 15 duplicates were removed, 123 records were screened, 116 were excluded, 7 reports were assessed for eligibility, 2 reports with a CBD:THC ratio below 20:1 were excluded, and 5 studies were included in the review. The included studies involved a total of 294 participants: Aran et al. 2021, Israel, 132 (44.89%); Hacohen et al. 2022, Israel, 82 (27.89%); Mazza et al. 2024, Brazil, 30 (10.20%); Trauner et al. 2025, USA, 30 (10.20%); Fortini et al. 2025, Argentina, 20 (6.80%). Mild to moderate improvement in persistent deficits in social communication and social interaction (PDSCSI) was reported in 66% of patients, with greater symptom severity associated with greater improvement; mild improvement in restricted, repetitive patterns of behavior, interests, and activities (RRPBIA) was observed in 28% of patients. Follow-up ranged from 2 to 6 months, the mean maximum dose was 22.1 mg/kg/day or an upper limit of 700 mg/day, the oldest patient was 25 years old, and most participants were male; assessments used the ADOS-2, SRS-2, RBS-R, Vineland-3, and VABS-II. The main adverse effects were dizziness, insomnia, colic, and diarrhea. According to the authors, a dysfunctional endocannabinoid system may play a role in ASD, CBD may be beneficial for core symptoms, particularly in the social domain, and it demonstrates a favorable safety profile; however, further research is needed because of the lack of distinction between syndromic and nonsyndromic ASD, variable doses and plasma levels, the inability to clearly differentiate ASD severity, and substantial sociodemographic variability.

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