What is ADD/ADHD
Attention deficit hyperactivity disorder (ADHD) is a brain based disorder characterised by inattentiveness, impulsivity, and hyperactivity, although symptom type and severity can vary from person to person. ADD, or attention deficit disorder is very similar to ADHD, but as the name suggests, often presents without hyperactivity as a symptom.
Although ADD and ADHD is usually associated with children it can continue into adulthood. Adults with ADHD may have trouble managing time, be disorganised, have difficulty with setting and achieving goals and often struggle keeping down a job.
Symptoms of ADD/ADHD
ADD and ADHD is characterised by three main groups of symptoms:
The person appears to procrastinate, be unable to complete tasks and/or frequently jump between tasks or move from one uncompleted activity to another. Inattention can also include:
- Lack of focus and an inattention to detail
- Carelessness and often making mistakes
- Trouble staying on topic, appears to not be listening to other, and do not follow social rules
- Forgetfulness about daily activities and keeping appointments
- Be easily distracted by others, noises or events
- Seeming to constantly daydreaming
Usually presenting more acutely in children than adults, hyperactivity may vary with age. Toddlers and preschoolers with ADHD tend to constantly be in motion (e.g. jumping, running etc.), and have trouble participating in group activities that require them to sit still. School-age children may present with similar habits, but the severity and frequency could be less (e.g. squirming, fidgeting etc.). In teens and adults, hyperactivity shows up as feelings of restlessness and/or having a hard time doing activities that require them to sit still.
- Fidgeting and squirming
- Inability to sit still, getting up frequently to walk or run around
- Inappropriate running or jumping
- Excessive talking
If a person presents with impulsivity, the often appear to be impatient, engaging in behaviours that some people might consider inappropriate or rude – especially in social interactions and situations. Impulsivity can also lead to accidents like knocking objects over or bumping into people. Children especially, may also engage in risky activities without considering the consequences and putting themselves in danger. They can also sometimes do things like:
- Not waiting their turn
- Blurt out answers before someone has finished asking a question
- Frequently interrupt or intrude on others, causing problems in social or work settings
- Start conversations at inappropriate times
- Appear reckless at times, engaging in potentially dangerous activities
ADD/ADHD Medications & Treatment
The usual treatment and care for ADD/ADHD is combination of medications and behavioural therapies to help manage symptoms. To date there is no cure for ADD/ADHD.
Most people work with their doctors to try different medications to help manage their symptoms with a variety of medications prescribed to treat ADHD. These can include stimulants and non-stimulants. Stimulants in particular have several side-effects that can include:
- poor appetite
- weight loss
- mood changes
- dry mouth
This form of treatment is particularly useful for children diagnosed with ADHD at a young age. Behavioural therapy aims to provide the diagnosed person as well as those close to them with the skills and strategies they need to help manage and improve symptoms by working to eliminate unwanted or problem behaviours, while teaching and strengthening positive ones.
How can CBD help for ADD/ADHD
Research & Scientific Evidence
Despite the popularity of cannabidiol (CBD), to date, there are no published data or randomised clinical trials that investigated the use of CBD specifically for the treatment of ADD/ADHD symptoms. However, there is some tentative evidence available from other studies.
Although not specifically looking at CBD, a 2017 randomised-controlled trial published in European Neuropharmacology suggest that cannabinoids may help improve symptoms of ADD/ADHD.
The double-blind, randomized placebo-controlled experimental trial involved 30 adults with a confirmed diagnosis of ADHD who were randomly decided into a treatment group and control group. Sativex oromucosal Spray with a 1:1 ratio of THC and CBD were administered to the treatment group for a period of 6 weeks during which cognitive performance, activity level, and behavioral symptoms of ADHD and emotional lability were investigated.
Although not statistically significant, the researchers found an overall pattern of improvement in ADHD symptoms in the experimental group, and in particular for symptoms of hyperactivity/impulsivity. They also found trends towards improvements for inattention and emotional lability.
In a 2018 study published in the Frontiers of Pharmacology, researchers investigated the oral use of CBD for the treatment of related symptoms and co-morbidities in children with Autism Spectrum Disorder.
The study consisted of 53 children (45 males and 8 females) aged between 4–22 years of age, who all received between 45 mg and 143 mg of CBD per day for a median of 66 days. The researchers report that symptoms of hyperactivity reduced in 68.4% of participants, remained unchanged among 28.9%, and increased among 2.6%. Negative side-effects reported were mostly mild and included sleeplessness and a change in appetite. Similarly, none of the participants were excluded or discontinued treatment nor had adverse effects.
The researchers concluded that there was an overall improvement in hyperactivity symptoms in children with an autism spectrum disorder, with its efficacy being “non-inferior” to methylphenidate, a medication often prescribed to manage hyperactivity.
In another study published in “Frontiers in Pharmacology” in 2019, researchers investigated the effect of CBD on mice deficient in AMPA receptor GluA1 subunits and who presented with novelty-induced hyperactivity.
The hippocampus is considered to be an important brain area for spatial learning and adaptation with abnormal activation in this area being strongly associated with excessive locomotor activity and hyperactivity – especially in novel environments. Therefore, the researchers targeted the hippocampus by injecting CBD directly into this region and found that the mice reduced displays of hyperactivity in new environments.
They found a significant reduction in the novelty-induced hyperactivity, leading them to hypothesize that CBD may dampen hyperactive hippocampal circuitries as well as other parts of the brain implicated in ADD/ADHD.
Anecdotal evidence suggests an increasingly popular perception that CBD, as well as cannabis itself, can be therapeutic for ADHD. Some users even report a preference for CBD and cannabis over-prescribed medications due to their more favorable side-effect profile and overall safety.
Despite this, reports from doctor’s who’s patients admitted to trying CBD for managing their ADHD symptoms, it seems that for about half of those trying CBD on their own – regardless of the quantity, quality, or type used – there is no improvement in their symptoms, but also no adverse side-effects. The other half of patients do however see an improvement in symptoms, especially with regards to hyperactivity – often reporting feeling less manic and more able to stay calm.
Similarly, in a study investigating online forums on cannabis use and ADHD, the researchers found that from these online discussions, cannabis is considered to be an effective way of self-medicating for ADHD. For instance, they found that 25% of individual posts indicated that cannabis is therapeutic for ADHD, 8% saying that it is harmful, 5% that it is both therapeutic and harmful, and only 2% saying that it has no effect on ADHD.
CBD as a complementary treatment for ADD/ADHD
CBD may be helpful as a complementary treatment for managing many of the side effects associated with many of the medications, especially stimulants, normally prescribed for ADD/ADHD.
So for instance, CBD has been shown to help modulate mood swings, a side-effect commonly reported with stimulant drugs prescribed for ADD/ADHD. Several studies now show that CBD encourages neural regeneration in areas of the brain responsible for mood regulation. Similarly, CBD prevents the overstimulation of your CB1 receptors, boosting the production of endocannabinoids such as anandamide (aka bliss molecule), while also binding to the 5-HT1A serotonin receptor thought to play a vital role in anxiety disorders.
Similarly, patients suffering from headaches and stomach pains – another common side effect of stimulant drugs – may find relief with CBD since it has been shown that CBD can significantly reduce pain by suppressing the α3 GlyRs receptors responsible for the sensation of pain.
The bottom line is that there is a shortage of scientific evidence regarding the use of CBD for the management of ADD/ADHD symptoms. Similarly, because there are no clinical trials as yet, dosage recommendations are problematic, leaving many patients and their caregivers to have to experiment on themselves.
That is why it is vital that the patient’s treating physician or medical practitioner needs to be consulted before using CBD for the management of ADD/ADHD symptoms. Not only can they assist in assessing dosage recommendations and monitoring of symptoms, but they can also advise with regards to potential drug interactions and side-effects.