CBD-rich cannabis did not improve sleep better than placebo in children with autism | Research

The takeaway

In a placebo-controlled trial of 150 children with autism, CBD-rich cannabinoid treatment was not superior to placebo for any sleep measure.

Parents of children with autism considering cannabinoid treatments for sleep, and clinicians advising them.

No sleep benefit over placebo in any measure

What the researchers found

CBD-rich cannabinoid treatment (20:1 CBD:THC ratio) was not superior to placebo for sleep in 150 children and adolescents with autism, including bedtime resistance, sleep-onset delay, and sleep duration.

Why it matters

Despite widespread anecdotal claims that cannabis products help autistic children sleep, this rigorous trial found no benefit over placebo, providing important data for families and clinicians making treatment decisions.

The numbers in context

150 participants randomized across three arms. 12-week treatment periods with 4-week washout. CBD:THC ratio was 20:1. No significant differences from placebo on any CSHQ sleep measure.

How the study worked

Double-blind, placebo-controlled crossover study of 150 children/adolescents with ASD. Three arms: whole-plant cannabis extract (20:1 CBD:THC), purified CBD/THC in same ratio, or placebo. Each treatment period lasted 12 weeks with 4-week washout. Sleep assessed via the Children's Sleep Habit Questionnaire.

What this study cannot tell us

Sleep was measured by parent questionnaire rather than objective measures like actigraphy or polysomnography. The CBD:THC ratio was fixed at 20:1, so other ratios might yield different results. The crossover design may introduce period effects.

How to read the evidence

Strong: large, double-blind, placebo-controlled crossover RCT with standardized assessment.

When this study was published

Published in 2022.

The bigger picture

This is one of the few placebo-controlled trials of cannabinoids for sleep in autism. The negative result challenges popular assumptions and underscores the importance of controlled trials over anecdotal reports.

Questions still open

Would different CBD:THC ratios be more effective for sleep? Could objective sleep measures reveal effects that parent reports miss? Did the placebo effect account for the improvements seen in both groups?

Common questions

Did sleep improve at all during the study?

Yes, sleep scores improved in both the cannabinoid and placebo groups, but the cannabinoid groups were not statistically better than placebo.

Was there any connection between sleep and behavior?

Yes. Regardless of whether participants received cannabinoids or placebo, improvements in sleep were associated with improvements in autistic core symptoms as measured by the Social Responsiveness Scale.

What forms of cannabinoid were tested?

Two forms were compared: a whole-plant cannabis extract and a purified CBD/THC extract, both at a 20:1 CBD:THC ratio. Neither outperformed placebo for sleep.

Read the original research

A Placebo-Controlled Trial of Cannabinoid Treatment for Disruptive Behavior in Children and Adolescents with Autism Spectrum Disorder: Effects on Sleep Parameters as Measured by the CSHQ.

Biomedicines, 10(7)

View on PubMed ↗Publisher’s paper ↗

Citation

Schnapp, Aviad; Harel, Moria; Cayam-Rand, Dalit; Cassuto, Hanoch; Polyansky, Lola; Aran, Adi. (2022). A Placebo-Controlled Trial of Cannabinoid Treatment for Disruptive Behavior in Children and Adolescents with Autism Spectrum Disorder: Effects on Sleep Parameters as Measured by the CSHQ.. Biomedicines, 10(7). https://doi.org/10.3390/biomedicines10071685