Key Insights

• Autism spectrum disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech and non-verbal communication, and restricted/repetitive behaviours. About 1 in 160 children worldwide have ASD.
• The exact causes remain unknown and there is currently no one standard treatment for ASD. A range of therapies are often used based on the needs of the individual
• Alicia Danforth and Charles Grob are leading the research into using psychedelics to treat ASD. While the clinical research is scarce, testimonials from members of the Autistic Psychedelic Community who use psychedelics are very positive

Author: Iain Burgess is the lead researcher at Blossom. He studied Global Health (MSc) and Physiology (BSc) and has researched the various scientific, societal, cultural and political dynamics that have shaped our understanding of psychedelics throughout history.

What is autism spectrum disorder?

Autism spectrum disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech and nonverbal communication, and restricted/repetitive behaviours. The effects of ASD and the severity of symptoms are different in each person [1].

There are four major types of ASD; autistic disorder, Asperger’s, childhood disintegrative disorder, or pervasive developmental disorder not otherwise specified (PDD-NOS). Now, under the criteria set out in the DSM-V, these conditions are now all called ASD [2].

Moreover, although autism is often not diagnosed until much later, under the DSM-V criteria, individuals with ASD must show symptoms from early childhood, even if those symptoms are not recognized until later in their life [2].

People living with ASD can have significant social, communication and behavioural challenges. For example, a person with ASD may not be fond of changes to their daily routine or often repeat certain behaviours. Other behaviours can include having trouble in expressing oneself and difficulties in relating to others [3].

The World Health Organization estimates about 1 in 160 children worldwide live with some form of an ASD [4].

Globally, autistic disorders account for more than 58 DALYs (disability-adjusted life years) per 100,000, the common metric used to assess the overall burden of a given disease. Thus, ASDs account for a substantial health loss across the life span [5].

The exact causes of ASD remain speculative, with both environmental and genetic factors thought to be involved.

Diagnosis & Conventional Treatments

Diagnosing ASD can be difficult given the wide range of symptoms and there are currently no medical tests, such as a blood test, to aid in diagnosis. Paediatricians look for signs of ASD during a child’s general visits at 18- and 24-months, even if they don’t appear to have any symptoms. At these visits, parents are asked questions regarding their child’s development and behaviour [6].

Screening tools do exist to help medical professionals diagnose autism. The Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) are considered the gold standard for diagnosing ASD [7].

At present, there is currently no one standard treatment for ASD. However, ways to minimize symptoms do exist.

Common interventions include behavioural management therapy, cognitive behavioural therapy (CBT), occupational therapy, speech-language therapy, and physical therapy to name a few. Early diagnosis and intervention, such as during preschool or before, are more likely to have major positive effects on symptoms and later skills [8].

There are currently no FDA-approved pharmacological treatments for autistic adults with social anxiety, and conventional anti-anxiety medications lack clinical effectiveness in this population [9].

Psychedelics and Autism

Research into the potential use of psychedelics to treat autism initially began in the 1960s and continued until the 1970s when psychedelics became Schedule I substances.

Alfred Freedman and colleagues are just one group of several that treated autistic children with psychedelics during the first era of research. In their study, Freedman and colleagues noticed significant psychological change after administering 50-200ug of LSD to their sample group (n=12) [10].

A more recent review of the literature from the many research groups of this era using LSD in the treatment of children with autism highlights the controversial nature and many methodological flaws with this research.

While issues regarding consent may not have to the fore at the time, conducting such experiments on children raises ethical concerns by today’s standards. Additionally, many of the findings suffered from major methodological flaws, so much so, that Sigafoos and colleagues conclude by stating the research from this era is of little relevance to modern research [11].

Nevertheless, the psychedelic renaissance we are experiencing has sparked a renewed interest in the potential of psychedelics to treat ASD. 

Modern Research into Psychedelics and Autism

While research into the effects psychedelics have on ASD is sparse when compared to other mental disorders like depression, some trials have taken place.

It should be noted that modern research is currently only looking at minimizing the negative effects of ASD, if we speak of treatment, it is this perspective, not ‘curing’ ASD that we’re talking about.

Working from the Harbor-UCLA Medical Center, Alicia Danforth and Charles Grob are leading the way in realizing the potential of psychedelics to treat ASD.

Sponsored by MAPS, Danforth and Grob published an initial review in 2016 proposing a new treatment model for social anxiety in autistic adults. The authors discuss the ability of MDMA to catalyze shifts toward openness and introspection and, given that MDMA-assisted therapy does not require ongoing administration to achieve lasting benefits, it could be an advantageous treatment strategy.

The aforementioned paper laid the foundations for a pilot study in 2018 in which MDMA-assisted psychotherapy was utilized to treat autistic adults.

Utilizing the Leibowitz Social Anxiety Scale (LSAS), the double-blind, placebo-controlled, randomized pilot study (n=12) found a significant reduction in social anxiety (d=1.4) after MDMA-assisted psychotherapy (75-125mg, 2 sessions). The observed reduction in social anxiety was maintained 6 months later.

Furthermore, in 2019 Danforth analysed the subjective experiences autistic adults reported after they took MDMA in nonclinical settings by conducting a retrospective survey (n=100) and qualitative interviews (n=24).

Findings from the study indicate that MDMA-assisted psychotherapy may be an effective catalyst in autistic adults for intra- and interpersonal change as well as participants reporting accounts of lasting transformation and healing from conditions such as trauma and social anxiety that are common in autistic populations.

The findings from the recent Phase III trial from MAPS using MDMA to treat PTSD may also have positive implications for using MDMA to treat social anxiety in people with ASD. PTSD and social anxiety are often experienced comorbidly and therefore, it could be possible that the positive results from this trial could be replicated in autistic adults with social anxiety. Nevertheless, controlled clinical trials will be needed to test this hypothesis.

How might psychedelic drugs treat ASD?

The exact mechanism by which psychedelic drugs can alleviate symptoms of ASD remains unknown. It has been postulated that classical psychedelics and entactogens, like MDMA, influence social processing through agonism at the 5-H2TA receptor in the brain which increases prosocial behaviour [12].

Additionally, the Default Mode Network (DMN) has been implicated in ASD as numerous neuroimaging studies have pointed out [13].

Given that it is hypothesized that psychedelics have the ability to alter the DMN once consumed, it could be possible that psychedelics mediate their therapeutic effects in ASD by altering the DMN. Further research is needed in order to elucidate the exact mechanisms by which psychedelics act in the brain of those with ASD. 

Psychedelic Industry and ASD

Within the psychedelic industry, Pilz BioScience appears to be the only company specifically focusing on utilizing psychedelics to treat ASD.

A subsidiary of the Vancouver based Nova Mentis Life Sciences Corp, Pilz BioScience is attempting to harness the potential of psilocybin to target the association between autism and neuroinflammation in the hope of optimizing cellular function as well as modifying cognitive perception.

Using their synthetic derivatives of psilocybin and psilocin to treat ASD, Pilz hopes to commence Phase I clinical trials in 2022. As further research emerges, perhaps so too will more companies and research groups targeting ASD.

 Although data from clinical trials is necessary and invaluable with regards to informing both medical professionals and regulatory bodies of the safety and efficacy of psychedelic drugs, so too are the accounts of people living with mental disorders.

In 2019, Aaron Orsini who lives with ASD published his book “Autism on Acid: How LSD Helped Me Understand, Navigate, Alter and Appreciate my Autistic Perceptions” in which he gives an account of his wholly positive experiences as being autistic experimenting with LSD.

Moreover, there exists an entire community of people with autism experimenting with psychedelics who offer support to others in similar positions. The Autistic Psychedelic Community (APC) is a collaborative co-learning community exploring the intersection of psychedelics and neurodivergence.

The APC recently published a book “Autistic Psychedelic – The Self-Reported Benefits & Challenges of Experiencing LSD, MDMA, Psilocybin, & Other Psychedelics as Told by Neurodivergent Adults Navigating ADHD, Alexithymia, Anxiety, Asperger’s, Autism, Depression, OCD, PTSD & Other Conditions.” Their first-hand accounts offer perspective on how people living with autism are benefiting from self-medicating with psychedelics.

The APC is currently working in collaboration with the research team at University College London on a survey study exploring the benefits and challenges of naturalistic psychedelic use in people with ASD. If you are a self-diagnosed and/or clinically diagnosed autistic adult who has experience with using psychedelic’s, you can take part in the survey here.

Based on preliminary research findings and the many positive anecdotal reports from members of the Autistic Psychedelic Community, psychedelics do show promise in helping people with ASD manage their symptoms. Ultimately, clinical trials will be needed to explore this potential therapeutic effect of psychedelic’s before they become a viable treatment option.

References

1. American Psychiatric Association. (2018). What Is Autism Spectrum Disorder? American Psychiatric Association. https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder

2. American Psychiatric Association. (2013). Autism Spectrum Disorder – Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Autism-Spectrum-Disorder.pdf

3. CDC. (2020). What is Autism Spectrum Disorder? Centers for Disease Control. https://www.cdc.gov/ncbddd/autism/facts.html

4. World Health Organization. (2021). Autism spectrum disorders. Geneva: World Health Organization. https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders

5. Baxter, A., Brugha, T., Erskine, H., Scheurer, R., Vos, T., & Scott, J. (2015). The epidemiology and global burden of autism spectrum disorders. Psychological Medicine, 601-13. doi: 10.1017/S003329171400172X

6. Alli, R. (2020). How Do Doctors Diagnose Autism? WebMD. https://www.webmd.com/brain/autism/how-do-doctors-diagnose-autism

7. McCarty, P., & Frye, R. (2020). Early Detection and Diagnosis of Autism Spectrum Disorder: Why Is It So Difficult? Seminars in Pediatric Neurology. https://doi.org/10.1016/j.spen.2020.100831

8. National Institutes of Health. (n.d). What are the treatments for autism? Bethesda: National Institutes of Health. https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments

9. MAPS. (n.d). MDMA-Assisted Therapy for the Treatment of Social Anxiety in Autistic Adults. San Jose: Multidisciplinary Association for Psychedelic Studies. https://maps.org/research/mdma/anxiety/autism

10. Freedman, A., Ebin, E., & Wislon, E. (1962). Autistic Schizophrenic Children. An experiment in the use of d-lysergic acid diethylamide (LSD-25). Arch Gen Psychiatry. https://doi.org/10.1001/archpsyc.1962.01710210019003

11. Sigafoos, J., Green, V., Edrisinha, C., & Lancioni, G. (2007). Flashback to the 1960s: LSD in the treatment of autism. Developmental Neurorehabilitation, 75-81. https://doi.org/10.1080/13638490601106277

12. Preller, K., & Vollenweider, F. (2019). Modulation of Social Cognition via Hallucinogens and “Entactogens”. Frontiers in Psychiatry, 881. https://doi.org/10.3389/fpsyt.2019.00881

13. Padmanabhan, A., Lynch, C., Schaer, M., & Menon, V. (2017). The Default Mode Network in Autism. Biological psychiatry. Cognitive neuroscience and neuroimaging, 476-486. https://doi.org/10.1016/j.bpsc.2017.04.004