The CBD industry is flooded with a variety of medical claims—many backed by data from pre clinical and clinical trials while others are anecdotal at best. While there is growing evidence supporting CBD’s broad pharmacological properties, it’s important to periodically evaluate where the scientific community is in relation to the marketing industry.
Why? Because there’s a tendency to extrapolate some of CBD’s clinically tested properties and apply them broadly across the medical field at large.
This might be the case when it comes to CBD’s effects on Attention-Deficit/Hyperactivity Disorder (ADHD). So far, clinical evidence demonstrating a link between CBD and ADHD relief is nascent at best, though some medical practitioners see change on the horizon.
According to Kelly Dorfman, MS, LDN, “most practitioners are somewhere between negative (there is little research) to cautiously optimistic about possibilities.”
There are several reasons for this tenuous balance, including from the multi-faceted nature of ADHD symptoms, a lack of medical research, and a hesitancy among practitioners to prescribe cannabis products.
While CBD research has evolved dramatically over the last few years, researchers still have a long way to go in determining CBD’s full biochemical potential. This is especially true when it comes to understanding the link between CBD and ADHD.
What is ADHD?
The National Institute of Mental Health (NIH) defines ADHD as a “brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
It is most commonly diagnosed in childhood, according to the Johns Hopkins Medicine Health Library, with some symptoms surfacing as early as preschool age or as late as elementary or middle school.
ADHD is characterized by severe and frequent inattention, impulsivity, and hyperactivity that can interfere with social, school, or job-related functions, according to NIH. Individuals with ADHD might showcase a combination of the following behaviors:
- Short attention span.
- Difficulty listening to others.
- Easily distracted.
- Struggles to organize tasks and schedules.
- Fidgets and feels restless.
- Runs or climb in inappropriate situations.
- Unable to play or engage in hobbies quietly.
- Difficulty waiting his or her turn.
- Overly talkative or interrupts.
- Tendency to blurt out answers.
- Takes frequent risks.
Medical experts use these symptoms to categorize three types of ADHD:
- Most common type of ADHD.
- Characterized by impulsive, hyperactivity, and inattention.
- Hyperactive and Impulsive:
- Least common type of ADHD.
- Characterized by impulsive and hyperactive behaviors without inattention and distractibility.
- Inattentive and Distractible
- Characterized by inattention without hyperactivity.
ADHD affects an estimated 4% to 12% of children, though boys are two to three times more likely to showcase signs of hyperactive or combined ADHD than girls.
It can be challenging to diagnose though, as the symptoms materialize differently in each patient, can change over time, and can sometimes resemble other behavioral problems. One key diagnostic element is that the symptoms must significantly impair functions at home and at school, according to Johns Hopkins.
How is ADHD Typically Treated?
There are two primary ways to treat ADHD, according to NIH:
- Stimulant Medications:
- Prescribed medication that increases two brain chemicals, dopamine and norepinephrine, which help control cognitive functions such as thinking and focusing.
- Typically provides an immediate release of stimulants that work for one to four hours, or as long as eight to nine hours.
- Must be timed with a child’s school and sleep schedule in order to avoid side effects such as insomnia or jitteriness, which can occur as the medication wears off.
- Common medications include: Ritalin, Dexedrine, Adderall, and Strattera, which is not a stimulant but can help regulate mood swings.
- Non-Stimulant Treatments:
- Focuses on behavior management skills for parents to help reduce stress and provide structure for the child.
- Typically helps improve targeted tasks such as completing schoolwork, but does not usually mitigate ADHD symptoms, such as inattention, hyperactivity, or impulsivity.
- Behavior management skills may include point systems, positive attention for desired behaviors occur, etc.
Related: CBD and Autism
What Do We Know About CBD and ADHD?
Many patients experience adverse side effects from ADHD medication, causing some to turn to CBD, medical marijuana, and other extracts from cannabis plants. In theory, CBD or THC would replicate the effects of traditional psychostimulant medication, but without the side effects.
But does it? Researchers aren’t sure.
While some psychiatrists do prescribe cannabis or CBD to ADHD patients, there are very few randomized controlled studies supporting this practice (though a few clinical trials are looking at THC’s effects on children with autism).
Additionally, of the few clinical studies that do evaluate cannabinoids and ADHD, most assess the effects of THC or THC/CBD adjunctively. Additionally, these studies are typically limited to a small sample size and rarely include children.
With these caveats in mind, here is the current state of CBD, THC, and ADHD research:
German researchers studied the effects of THC on 30 ADHD patients and found that cannabis helped improve concentration and sleep while reducing impulsivity among all 30 subjects.
A 2016 qualitative analysis of 401 online posts on ADHD forums found that 25% of entries indicated that cannabis provided therapeutic relief, while 8% said it was harmful. While the study did not form any clinical recommendations or statistical findings, it “could shape ADHD patient and caregiver perceptions, and influence cannabis use and clinical care.”
A 2017 study out of Europe tested the cognitive performance of a 1:1 CBD/THC medicine on 30 adult ADHD patients. Researchers observed a “nominally significant improvement in hyperactivity/impulsivity and cognitive measure of inhibition,” though the results did not meet a statistically significant threshold.
This study lends support to the medical theory that CBD may make more dopamine available to the brain, replicating the effects of stimulant medications typically prescribed to treat ADHD.
What’s Behind This Lack of Conclusive Data?
There are a few reasons for the dearth of CBD add ADHD research:
According to Dorfman, economic opportunity drives a lot of medical research. Essentially, companies need a financial motive in order to justify investing time and resources. Without patent protection or the opportunity to market medical products, companies have little incentive to fund any studies.
Medical experts are still working to fully understand CBD and THC’s biochemical properties, especially in conditions like ADHD where symptoms manifest differently in each patient. But experts like Dorfman are hopeful this will soon change.
Since ADHD symptoms affect each patient differently (i.e., some patients will exhibit inattention and slow processing speeds while others will showcase hyperactivity and impulse control), Dorfman advocates for a targeted, patient-centric approach to CBD treatments.
“[CBD] will be most effective if we can identify the sub-group of people within the ADHD diagnosis that will respond best to its unique homeostatic characteristics,” she says. “Since CBD receptors are so widespread and the possible clinical applications so vast, research has only scratched the surface of what is possible.”
Other medical experts are not so sure.
“During development, I worry about cannabinoids, both CBD and THC,” said a UCLA doctor in an interview with the magazine Additude. “There are adenosine receptors (and CB2 receptors) on the microglia that are critical for brain development, and CBD inhibits adenosine uptake. This may be a beneficial factor for epilepsy and autoimmune and inflammatory diseases, but who knows for ADHD.”
A third potential reason is the fact that many of the would-be test subjects are children.
There is a great divide within the medical community about prescribing cannabis extracts to children, though opposition is more heavily focused on THC. Although groups like the American Pediatrics Association largely oppose medical marijuana, some experts are starting to establish a framework to help guide the use of cannabis products in pediatric care.
Some studies have also found ADHD to be a risk factor for substance abuse, which further complicates the relationship between cannabis-based treatments and ADHD.
For example, a 2014 study found that childhood inattention disorder and hyperactivity to independently associated with cannabis use later in life. A separate study also found that hyperactivity and impulsivity “confer the greatest risk for adolescent cannabis use disorder.”
What’s In Store For CBD And ADHD Treatments in the Future?
While the link between CBD and ADHD relief is far from conclusive, Dorfman and others hope to add some perspective to the debate.
“The medical professionals that are willing to recommend CBD are generally working with complex cases where the other clinical options have unacceptable side effects and/or are ineffective,” she says. “There is always uncertainty in the scientific community and always people warning to stay away until more studies are done. It is a safe position unless you have a child with issues.”
This is essentially the same framework that gave rise to the recently approved cannabis-based epilepsy drug and is the very premise that the American Pediatrics Association says helped shaped its stance on a “compassionate use” of THC products for children with debilitating conditions.
It will be a while before we see more clinical data in the field of CBD and ADHD, but experts like Dorfman believe it’s time to start framing CBD less as a natural alternative to ADHD medication and more as a targeted treatment option that can offer relief in a way that other clinical options cannot.