What’s the big deal? CBD for ADHD
“If you would just focus, you could do everything.” This rule, probably, works for everyone except people with attention-deficit hyperactivity disorder (ADHD). The brain of the individuals with this condition never stops. Imagine scattered beads so that each bead is your thought. Is it real to focus on just one? No, it isn’t. The same feeling comes to each person with an ADHD diagnosis when trying to focus on only one thing. Some people state it’s no big deal and argue it’s an excuse or a copout for being lazy. Remember, it is a big deal, and this disease requires proper diagnosing and serious treatment, as it is usually accompanied by depression and other conditions that could significantly worsen the patient's quality of life.
What is ADHD?
ADHD is a mental health disorder that can cause above-normal levels of impulsive and hyperactive behaviours. People with an ADHD diagnosis usually also have trouble focusing their attention on a single task or can still for long periods of time.
Who gets ADHD?
ADHD is not one of the diseases that occurs only in childhood or appears in men or women only. Both adults and children can have this disorder, and both males and females are susceptible to this condition - the only difference is in the frequency of its occurrence. ADHD is a neurodevelopmental disorder that most often occurs in children.
The average age of ADHD diagnosis is seven, while its symptoms typically appear between the ages of three and six. As for the male or female prevalence, males are three times more likely to be diagnosed with this condition than females. According to statistics, during their lifetimes, 13% of men will be diagnosed with ADHD, while for women, the risk of having this disease is only 4.2%. In addition to this, there are also demographic factors that may impact the risk of being diagnosed with ADHD. For example, children from households with English as their main language are more than four times as likely to be diagnosed in comparison with children living in households where English is the second language. Also, children living in households with a poverty rate less than twice the national poverty level are at a higher risk than children in higher-income households.
Many conditions affect certain races in different ways, but for ADHD, everyone is equal. The disease impacts children of all races, including:
- Whites: 9.8%
- Blacks: 9.5%
- Latinos: 5.5%
Children are diagnosed at different ages. The estimated number of children diagnosed with ADHD in the US, according to a national survey held in 2016, is 6.1 million (9.4%). This number includes:
- 388,000 children aged 2-5 years
- 4 million children aged 6-1 years
- Three million children aged 12-17 years
Detecting symptoms of this condition often differs from one case to another, but the more severe the symptoms, the earlier the diagnosis. Moreover:
- The average age of ADHD diagnosis for children with a mild form of the disease is eight;
- The average age of ADHD diagnosis for children with a moderate form of the disease is seven;
- The average age of ADHD diagnosis for children with a severe form of the disease is five.
Also, according to a survey, six in ten children diagnosed with ADHD in the US have at least one other mental, behavioural, or emotional disorder. Other conditions that may also affect children with ADHD are:
- Tourette’s syndrome
- autism spectrum disorder
- learning disabilities
- bipolar disorder
- substance abuse
- sleep disorders
- antisocial behaviour
Are cases of ADHD rising?
Cases of ADHD have significantly increased in the past several years. According to the American Psychiatric Association (APA), 5% of American children are diagnosed with ADHD, while the Centers for Disease Control and Prevention (CDC) estimates this number to more than double. According to the CDC data, 11% of American children had ADHD in 2011. This amounts to a 42% increase between 2003 and 2011. This growth is reflected in the global ADHD market size, affecting the segment forecasts. The ADHD market size was valued at $16.4 billion in 2018 and is estimated to exhibit a compound annual growth rate (CAGR) of 6.4% over the forecast period. Approval of new drugs, product launches worldwide, and increased research and development activities are the main drivers of the global ADHD market. The growing number of people suffering from mental health disorders, including ADHD, has caught the attention of governments all over the globe, encouraging them to take the necessary steps to address this disease.
The global ADHD market has been segmented into hospital and retail pharmacies, based on the distribution of the drugs. In 2018, retail pharmacy accounted for the maximum market share being driven by an increasing number of prescriptions and a rise in inpatient care initiatives by retail pharmacies. Due to the lengthy nature of ADHD treatment, ADHD inpatients are fewer in number compared to patients in home care settings. People with this condition prefer to purchase medications from retail pharmacies rather than hospitals - therefore, this segment is expected to retain its lead throughout the forecast period. The retail pharmacy segment is also anticipated to register the highest CAGR of 6.6% from 2019 to 2025.
From the patient's point of view on ADHD, the cost is one of the main factors when it comes to disease diagnosis and treatment. According to a study held in 2007, an average “cost of the disease” for a person was $14,576 per year, while today these numbers are considerably larger. Medications and treatment plans for ADHD patients can be expensive, but they aren’t the only costs to consider with an ADHD diagnosis. Among other factors that can add cost can be:
- loss of work;
- education expenses;
- healthcare costs;
- juvenile justice.
ADHD shouldn’t be underestimated. People with this diagnosis aren’t rude or lazy - they just think differently. The brains of these individuals may be hundreds of miles away from the place they are, on ten different topics, making them struggle with their own mind as some people struggle with real physical pain. This disease requires understanding and treatment, not re-education and discipline.
What are the symptoms of ADHD?
Besides the statistical difference between men and women, symptoms of ADHD also differ among boys and girls. There still isn’t a scientific explanation for this phenomena, and many researchers explain it by the nature of ADHD symptoms, which makes boys’ condition more noticeable than it is in girls. Boys tend to display externalised symptoms, such as:
- hyperactivity, such as running and jumping
- lack of focus, including inattentiveness
As for girls, ADHD symptoms are not so pronounced, that makes it easy to overlook the disease as it doesn't look like “typical” ADHD behaviour. Symptoms of this condition in girls may include:
- anxiety and low self-esteem
- being withdrawn
- impairment in attention
- verbal aggression, such as taunting, teasing, or name-calling
A wide range of different behaviours is associated with ADHD, and many of them can vary between men and women, although the most common signs of ADHD condition for both sexes are:
- being forgetful about completing tasks
- having trouble focusing or concentration on tasks
- having difficulty sitting still
- being easily distracted
- interrupting people when they are talking
People diagnosed with ADHD may have one or several of these symptoms, and additional diagnostic methods are needed to make a definitive diagnosis. Moreover, the symptoms may vary depending on the type of ADHD. There are three main types of this disease to make ADHD diagnosis more consistent. These categories include:
- Predominantly inattentive type. As the name of the first ADHD type suggests, people with the predominantly inattentive type of the disease have extreme difficulty focusing, following instructions, and finishing tasks. People with this ADHD type often:
- get bored quickly
- miss details
- are easily distracted
- don’t seem to listen
- have difficulty learning new information and organising thoughts
- move slowly (it may appear they are daydreaming)
- have trouble following directions
- process information less accurately and more slowly than others
Children with this type of ADHD may not receive a proper diagnosis as the symptoms are not pronounced. This type of disease is most common among girls with ADHD.
- Predominantly hyperactive-impulsive type. People with the second type of the disorder show primarily impulsive and hyperactive behaviour. Such behaviour may include fidgeting or interrupting people when they are talking. Inattention doesn’t refer to the main “signs” of this ADHD type, although people with predominantly hyperactive-impulsive type may still find it difficult to focus on different tasks. People who are hyperactive or impulsive often:
- talk constantly
- feel restless
- are constantly “on the go”
- have trouble engaging in quiet activities
- have difficulty sitting still
- are impatient
- act out of turn
This type of disease is more common among boys, and its symptoms are easier to diagnose in comparison with the first ADHD type.
- Combined hyperactive-impulsive and inattentive type. According to the National Institute of Mental Health, a combination of two ADHD types is the most common among children. People with combined hyperactive-impulsive and inattentive type of ADHD display symptoms of both these conditions. These include above-normal levels of activity and energy, inability to pay attention and focus on tasks, and a tendency toward impulsiveness.
The type of ADHD determines the following disease treatment, so it is crucial to diagnose a patient properly. The type of disorder may change over time, so the treatment may change too, so all ADHD patients need to be re-diagnosed over time.
You may also have heard the term ADD and wondered what the difference between it and ADHD is. ADD means attention deficit disorder and was previously used to describe individuals who have problems paying attention but aren’t hyperactive. Today, it is an outdated term and is substituted with the predominantly inattentive type of ADHD. The term ADHD is currently overarching and became official in May 2013.
What causes ADHD?
Although ADHD belongs to common diseases of the 21st century, researchers and doctors still aren’t sure what the main cause for this condition is. This disease is believed to have neurological origins, but researchers state genetics may play an important role as well. Nowadays, no one knows exactly what causes ADHD and how to prevent this condition, but in some studies, a neurotransmitter called dopamine is considered a possible contributor to ADHD. Dopamine is a chemical in our brain, which is responsible for the transmission of signals from one nerve to another. It also plays an important role in triggering movements and emotional response. In addition to this, dopamine allows us to take action to achieve specific rewards and is responsible for feelings of pleasure and reward.
So what is the link between dopamine and ADHD? In a range of studies, researchers have observed that people with or without ADHD have different levels of this hormone in their brains. In further research, it was found that this difference was related to the concentration of certain proteins in the neurons of the central nervous system of people with ADHD. Individuals diagnosed with ADHD had a lower concentration of proteins called dopamine transporters that may be a risk factor for ADHD. However, low concentration or low dopamine transporter density (DTD) doesn’t mean that people will definitely have this disease. A holistic review is needed so that doctors can make a formal diagnosis.
To date, there is no single test to check if you or your child have ADHD; clinicians state ADHD diagnosis can’t be made based on only one test, therefore evaluation of the symptoms you or your child has had over the previous six months is needed. Doctors usually gather information from family members and teachers to review the disease symptoms of a child. In addition to this, they perform a physical exam to check for other health problems. Different checklists and rating scales can also be made to review the ADHD symptoms. If you suspect that your child has ADHD, you can talk to the school counsellor as well as ask your doctor about getting an evaluation. If healthcare professionals suspect ADHD, they may refer your child to an ADHD specialist or suggest making an appointment with a neurologist or psychiatrist.
How is ADHD treated?
As for ADHD treatment, it typically includes medication, behavioural therapy, or both. Some therapy methods may also include psychotherapy or talk therapy. During the talk therapy sessions, patients can discuss how ADHD affects their life and the possible ways to manage it. In many cases, medication alone is an effective treatment for this condition, although, according to the National Institute of Mental Health, including other options is also important. For example, behavioural therapy, which is often used along with medication treatment, can help with learning how to monitor and manage your behaviour. Let’s look at therapeutic ADHD treatments more in-depth:
- Psychotherapy. This type of ADHD treatment can be useful in getting your child to open up about their worries and feeling of coping with the disease. Psychotherapy can help children better handle relationships with peers or authority figures. Also, in psychotherapy, a child may be able to evaluate his behavioural patterns and learn how to make good choices in future. Psychotherapy may also include family therapy, which is a great way to discuss all worries together and figure out how best to work through disruptive behaviours.
- Behaviour therapy. The primary goal of behavioural therapy is to explain to a child how to monitor his behaviour and how to choose those behaviours appropriately. During the behaviour therapy sessions, parents, the child, and in some cases, the child’s teacher work together. As a team, they develop different strategies for how a child behaves in response to certain situations. With the help of these strategies, the child can learn suitable behaviour and assess the correctness of their actions.
- Support groups. Support groups are aimed at helping parents of children with ADHD connect with others who may have similar problems and concerns. Support groups always meet regularly and can be an excellent resource for different ideas and strategies for coping with ADHD, especially if your child has not long been diagnosed. Knowing you are not alone can be a huge relief for parents coping with their child’s ADHD diagnosis.
- Social skills training. This type of therapy can be useful if a child with ADHD shows serious issues dealing with social environments. Similar to behavioural therapy, the primary goal of social skills training is to explain to the child more appropriate behaviours and to help them play and work better with others. A therapist may try to teach a child such behaviours as:
- sharing toys
- turn taking
- dealing with teasing
- asking for help
Medications are an integral part of ADHD treatment and can be very helpful for individuals living with this disease. Most of the prescribed drugs for this condition are designed to affect brain chemicals, enabling you to better control your impulses and actions. Two main types of ADHD medications include stimulants and non-stimulants:
- Central nervous system (CNS) stimulants. CNS stimulants are the most commonly prescribed class of ADHD medications. The main goal of these drugs is to increase the amount of brain chemicals called dopamine and norepinephrine. Dopamine is responsible for emotional responses and behaviour, while norepinephrine is thought to help with attention and memory. The effect provided by CNS stimulants improves concentration and helps ADHD patients focus better. The most common CNS stimulants prescribed for ADHD include:
- amphetamine-based stimulants (Adderall, Dexedrine, Dextrostat)
- methylphenidate (Concerta, Daytrana, Metadate, Ritalin)
- dextromethamphetamine (Desoxyn)
- dextromethylphenidate (Focalin)
- Non-stimulant medications. This type of ADHD medication is usually considered when CNS stimulants haven’t provided the desired effect or have caused serious adverse effects. Non-stimulant medications also provide improvement in attention and memory by increasing the levels of dopamine and norepinephrine but work in another way than CNS stimulants. The most common non-stimulants prescribed for ADHD are:
- atomoxetine (Strattera)
- antidepressants like nortriptyline (Pamelor)
- guanfacine (Intuniv)
- clonidine (Kapvay)
As with all medications, both CNS- and non-stimulants have side effects. The more common adverse effects are similar for both types of drugs, although some may be stronger for CNS stimulants. side effects of ADHD medications include:
- trouble sleeping
- weight loss
- stomach upset
- dry mouth
More serious side effects are rare, although, for certain stimulants, the following conditions may appear:
- allergic reaction
- increased blood pressure
- suicidal thoughts or actions
Medications prescribed for ADHD treatment can provide very effective results, especially when combined with other treatment methods, such as behaviour therapy or psychotherapy. However, it is crucial to monitor the condition of a patient throughout the whole course of his treatment in order to correct unnecessary doses of medications or notice side effects in time. Research of possible ADHD therapies is ongoing in search of effective and safe methods of treatment for all types of the disease. A remedy, which is able to manage ADHD symptoms and improve the quality of life for all the patients is the primary goal for scientists all over the globe.
Can CBD help?
Cannabidiol is one of more than a hundred different compounds found in the cannabis plant. Nowadays, you will hardly find a person who has never heard about this chemical as its active legalisation for medicinal purposes has shaken the whole world and turned traditional medicine upside down. Research of medicinal cannabis and its therapeutic benefits is actively ongoing, and scientists from leading laboratories in different countries reveal more and more possible uses for this compound. The range of diseases and conditions that could potentially be treated with cannabidiol and other cannabinoids is constantly increasing, as well as the number of successful results from various studies and trials. The cannabis plant remains a mystery for modern scientists, although it gradually reveals its potential, allowing us to include a new type of therapy into a usual treatment - natural therapy. With its natural origin and complete absence of any psychological effects, along with potent therapeutic effectiveness, cannabidiol becomes more often used for different conditions, starting with anxiety and depression, and for diseases of a global scale, such as cancer, arthritis, Alzheimer’s disease, and diabetes.
Cannabidiol has established health benefits for a range of different disorders, including several mental conditions, although its effects on behavioural and neurological conditions are still being investigated. It still remains unclear whether CBD oil can ease the symptoms of ADHD or prevent this disease, although positive effects of this compound demonstrated by a range of studies shows potential for CBD to be used as a treatment for ADHD patients.
What does the research say?
Currently, research on CBD as a potential ADHD treatment is limited. Moreover, much of what we know about its therapeutic benefits for this disease stems from research on the cannabis plant as a whole, not CBD as an isolated compound.
Being an extremely complex disorder, ADHD is thought to be caused by a combination of environmental and genetic factors. This disorder is associated with widespread brain abnormalities, spanning from the prefrontal cortex to the cerebellum. Regardless of whether genes or environment have played a crucial role in the disease’s appearance, all individuals diagnosed with ADHD have lower than average levels of dopamine and norepinephrine. Both of these chemicals are neurotransmitters and play a critical role in the motor and reward systems - thus the lack of them may explain the inattentive and hyperactive-impulsive symptoms.
Let’s explore how we might replenish the level of these hormones, and the main roots of the problem:
- Environmental and genetic factors. According to studies held to investigate the link between the environmental and genetic factors of ADHD, the chances of inheriting ADHD from a parent vary from 60% to 90%. This statistic suggests genetics plays the primary role in the onset of the disease, although it’s not the only factor that may contribute to it. Chromosomal deletions and duplications, where parts of the genetic code are either missing or repeated, are also common in individuals diagnosed with ADHD. These likely cause the associated brain abnormalities. Besides genetics, environmental factors during fetal development and infancy can aggravate pre-existing genetic issues and lead to the disease’s presence. For example, such factors as prenatal exposure to alcohol or nicotine, malnutrition, low birth weight, and a lack of socialisation early in life may noticeably increase the risk of ADHD. Of course, it is impossible to alter genes with cannabinoids or any other medications, although CBD may help with addictions, thereby reducing the risk of fetal exposure.
- Dopamine deficiency. We have already mentioned that people with ADHD have lower levels of dopamine - the neurotransmitter, which affects reward-motivated behaviour. Pharmaceutical stimulants, such as Adderall and Ritalin, are commonly prescribed for people with an ADHD diagnosis to increase the availability of dopamine in the brain. However, these medications don’t work for everyone and pose a risk of severe or even life-threatening adverse effects. Whereas, the same effect can be achieved from some cannabinoids, such as THC, which increase dopamine activity in the brain by triggering the reward system. Cannabidiol may also increase the dopamine availability, but in a different way to stimulants and all other drugs with a potential for abuse. In one of the preclinical trials, mice with lower than average levels of G protein-coupled receptors (GPR6) in the brain showed higher levels of dopamine than mice with a normal amount of these receptors. This indicates that reducing activity in GPR6 increases dopamine production. What is the role of CBD in this process? A brain receptor works as a “parking space” for different neurotransmitters, allowing them to park and produce their effects. However, when this space is already occupied by some other chemical, all other neurotransmitters, hormones, or compounds will no longer be able to park there. CBD can park on GPR6 receptors. This compound does not do anything once there, though it reduces activity in these receptors by taking up space. Thus, theoretically, this may increase dopamine levels.
- Norepinephrine deficiency. Besides low levels of dopamine, individuals with ADHD diagnosis often experience norepinephrine deficiency. Norepinephrine is a hormone and neurotransmitter vital for a wide range of biological processes in our body, including movement and blood pressure. Non-stimulant medications, such as clonidine and atomoxetine, are aimed at increasing levels of this hormone to improve attention and lower hyperactivity and impulsivity in ADHD patients. The locus coeruleus (LC) region of our brain plays a critical role in the ability to concentrate and is a principal source of norepinephrine. When we consume CBD oil, the compounds engage with two receptors in your body. These receptors, known as CB1 and CB2 cannabinoid receptor types, have a direct effect on specific parts of our body. CB1 cannabinoid receptors appear throughout the LC, and stimulating these receptors seems to increase the release of norepinephrine into the rest of the brain. One of the studies has shown that some synthetic cannabinoids created in the lab may increase norepinephrine activity in the locus coeruleus region, thereby raising dopamine levels. In addition to this, cannabinoids also show a potential to regulate the LC area of the brain by preventing over-activation, which is one of the possible causes for the decreased attentiveness and ability to focus. As synthetically created cannabinoids show positive results, it is believed that plant-based treatments may produce similar effects on ADHD symptoms. The beneficial effects of CBD are also possible due to the ability of cannabinoids to inhibit monoamine oxidase (MAO), which helps metabolise hormones, including dopamine and norepinephrine. Slowing the breakdown process of these neurotransmitters can lead to increased levels throughout the brain.
What about CBD for ADHD?
While there is a lot of research on the effects of cannabinoids on the brain, there are very few studies specifically on ADHD. The few that do exist show there is potential for this cannabinoid to be used as an ADHD treatment, but further research is necessary. In a preclinical trial held in 2012, researchers used a drug called MK-801 to induce hyperactivity and inattentiveness in rats to mimic ADHD symptoms. Pretreatment with cannabidiol reduced hyperactivity but did not appear to affect attention span in animals. Another clinical trial held in 2017, compared the effects of treatment in 30 people diagnosed with ADHD. One group of participants was treated with a placebo, while another group took Sativex - an oral spray containing a 1:1 ratio of CBD to THC in its composition. The group given Sativex showed improvements in attention span, hyperactivity-impulsivity, and emotional control, while the placebo group did not show any behavioural changes. Individuals with ADHD diagnosis may represent a subgroup of patients who experience a reduction of the disease symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the theory of cannabis use in ADHD patients and the need for further studies to evaluate the role of the endocannabinoid system in ADHD treatment.
A recent study held in 2019 aimed to evaluate the effect of cannabinoids in the treatment of mental disorders and their symptoms. In this systematic review, the results of the studies, published between 1980 and 2018, were evaluated. Authors of the study considered all studies examining any type and formulation of a medicinal cannabinoid in adults for treating anxiety, depression, psychosis, post-traumatic stress disorder, ADHD, and Tourette’s syndrome, either as the primary condition or secondary to other medical conditions. In total, eighty-three eligible studies were included in this meta-analysis. Pharmaceutical THC (either with CBD or without it) showed the following effects:
- improved anxiety symptoms among individuals with other medical conditions, such as chronic non-cancer pain and multiple sclerosis
- worsened negative symptoms of psychosis (in a single study)
- no significant effect on any primary outcomes for the mental disorders
- increased the number of people who had adverse episodes (in comparison with placebo)
Currently, there is evidence to suggest that cannabinoids can improve psychosis, post-traumatic stress disorder (PTSD), depressive disorders and symptoms, anxiety disorders, ADHD, and Tourette’s syndrome, although it is still not enough to state the efficiency of cannabinoids for the treatment of these conditions. Preliminary evidence obtained in a range of studies supports the theory of CBD or THC use for ADHD, although no definitive conclusions can be drawn yet. Additional high-quality studies and trials are needed to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework.
Is CBD safe?
As for cannabis safety, while the existing research shows cannabinoids indeed have potential, more research is needed to determine its safety, especially considering the likelihood of ADHD onset during childhood. However, according to the Centers for Disease Control and Prevention, 5.2% of children with ADHD already take traditional stimulant or non-stimulant medications, most of which are not recommended for use in patients under six years old. In one study, a group of 20 children took a cannabis extract containing 100mg/ml CBD and 2mg/ml THC over ten weeks. Most of the study participants had mild adverse effects, such as poor balance and tiredness, but these resolved themselves within eight weeks. These results are encouraging, though further study is needed to determine the long-term effects of the use of the cannabinoids. When it comes to treatment of adults, there’s a growing body of evidence suggesting that CBD has very few side effects. Even the World Health Organization reported that cannabidiol is safe and nonaddictive.
What is the bottom line?
Nowadays, more than 16 million children in the US have an ADHD diagnosis, while it is estimated that more than 26 million Americans struggle with this disease at some point in their lives. This situation is not only in America - the global rate of ADHD cases is also growing, impacting children and adults of all races. If cannabinoid treatment can help even a fraction of these people, an enormous amount of lives all over the globe could be improved. Maybe it is too early to inspire hope and rely entirely on CBD, believing that this natural treatment will substitute current medications, but the studies are ongoing. Positive results of studies and animal trials, along with anecdotal evidence, support the theory of cannabinoid use for ADHD and Tourette’s syndrome treatment and serve as a starting point for new research. Negative results of studies also contribute to research forcing scientists to pay attention to new aspects and features of the disease, as well as look at the treatment from a different angle. Nowadays, we have reasons to believe that CBD can become an effective addition to modern ADHD treatments or even substitute them one day, although we have to wait for the confirmed results of studies and FDA-approved therapy.