Treatment of Persons on the Autism Spectrum with Cannabis

Objective: To globally identify autism families choosing cannabis as a treatment option.

At UF4A.ORG rarely a day goes by without a distressing phone call or email from a parent with a child on the spectrum.  We are in a unique and fortunate position to help these parents.  We can give them direction and most importantly, hope.  Together, we can also provide important information to doctors and law makers.  Accordingly, our goal is to start disseminating information and sharing our collective experience.  We need your help to do that and we are asking for a few minutes of your time in filing out this survey.  

The survey consists of approximately 45 questions.

Please try to be detailed in your responses where appropriate. If you do not have an answer or do not feel comfortable answering a question, please state "N/A" or "do not wish to discuss" or "uncomfortable" or the like, before moving on.  We will never reveal anybody's identity or personal information without their consent, so if you wish to leave your family's name out of the survey, please indicate that where appropriate.

Thank you in advance for being so generous with your time.  We are tremendously grateful for your help and feedback.  Please contact for any technical assistance, questions or concerns.  

The time to demonstrate the success that we have had and that other families can have has arrived. We eagerly await your valuable input!

Thank you,

Mieko Hester-Perez & UF4A.ORG, an informational website

Describe any family history with autism? *
What is your child’s primary diagnosis and where on the Spectrum does your child fall e.g. Autism, Severe Autism, Asperger’s, etc. *
What is your child’s official diagnoses? *
How many children do you have and what are their ages? *
What is the name, age, weight and residence of your child that is diagnosed with autism (or similar condition on the spectrum) *
If you do not want your child's name to be revealed, please leave out your child's name.
What is your full name, residence, occupation, age, and marital status? *
If you do not wish to be identified, feel free to leave out your name.
Pre-Cannabis Treatment History
Please describe which drugs and combinations of drugs were least effective or most harmful and why *
Describe in detail the incident that sent you to seek help beyond general medicine. *
What types of doctors did you visit? *
Please list all the prescription drugs your child was placed on, and what those drugs were supposed to do, if you know *
On a scale of 1 to 10, with 1 being "Not Helpful At All" and 10 being "Extremely Helpful" Were the prescription drugs helpful? *
Not Helpful At All
Extremely Helpful
How old was your child when you discovered he/she was autistic *
What foods or natural supplements/remedies have been most helpful and why *
How many conventional doctors did you visit to treat the condition before cannabis *
Please describe which drugs and combinations of drugs were most effective and why *
Please list the various combinations of drugs your child was placed on at one time if you can recall *
Please describe one or two of the worst incidents associated with your child’s condition *
Please describe a typical day or typical behavior exhibited by your autistic child before cannabis treatments *
Describe in detail the incident when you first suspected your child was autistic *
General Cannabis/Autism
Please describe your feelings (e.g. excitement, hope, despair, worry, etc.) when you discovered that cannabis might help treat you child’s condition.   *
Please describe how you feel now that you have placed your child on cannabis and whether your initial concerns or other emotions were validated or unfounded/overblown *
Please describe how you discovered that cannabis was a potential treatment and what action you took as a result (e.g. called Mieko who sent me to Dr. Hedrick, or found which gave me more info.) *
Please list the most effective treatments with # 1 being the most important medication for your child’s Autism.  For example, #1 cannabis, # 2 Ritalin, #3 Zoloft etc *
Is Cannabis effective in the treatment of your child on the spectrum? (Scale 1-10) *
"1" being not helpful at all, and "10" being extremely helpful
Not helpful at all
Extremely Helpful
What is the best part about the treatments? *
What concerns did you have upon learning cannabis could be a treatment (e.g. losing assistance funding, long term effects on child, where to get it, etc.) *
Technical Data
Have you had to increase the amount of each dose to get the desired effect? *
Have you had a bad experience with a specific batch of medicine or strain, and if so, what happened? *
Do you require edible that are Gluten Free or Casein-Free or both? If so, why? *
Please describe how you acquire the medicine? *
If you know, what is the optimal cannabinoid profile (ratio of THC/CBD/CBN)  of the strains that are in your edibles e.g. 15% THC, 1%CBD, 1% CBN *
At any point have you stopped administering the cannabis? If so, for how long and why? *
How often do your administer it e.g. twice per week, once a day, etc. *
What form of the medicine does your child take e.g. edibles, tinctures, vaporize *
How much do you give to your child in one dose e.g. a quarter-sized brownie *
If you know, what type of strain of Cannabis is best for your child: indica, sativa, hybrid, sativa-dominant hybrid or indica-dominant hybrid. *
What is the name of the doctor that recommnended Cannabis? *
How long after the dose before you notice an effect e.g. within one hour or within 20 minutes? *
Roughly how long does each dose last? *
How long has your child been on Cannabis (years and/or months) *
At what time of day/night do you administer or does it vary? Why? *
If you know, what is the street name or names of the strains (OG Kush, Sour Diesel, etc.) *
The Results of your Cannabis Treatments
If applicable, please describe how your child is better main-streamed after cannabis e.g. able to attend more school or participate more in school or extra-curricular activities, able to go to restaurants *
How has helping your child get through this illness affected your life? *
What are the effects that you notice e.g. pacified/no longer aggressive, sleeps through the night, more eye contact, more social, better connection with siblings, more continent, worse off than before, etc. *
Would you say that your family has a life again, and if so how provide an example e.g. can go into to public more easily now. *
How has using cannabis as medication for your child changed your life as a parent? *
Did Cannabis save your child’s life, and if so, how? *
How much weight did your child gain or lose, if any. (Please list starting weight and current weight) *
Release and License Form (PLEASE FILL IN YOUR FULL NAME AND ADDRESS IF YOU AGREE TO THE FOLLOWING. We await your valuable input! Thanks so much, Mieko) *
I hereby give the Unconventional Foundation for Autism ("UF4A.ORG") an informational website, its officers, employees, agents, and third parties the absolute and irrevocable right and permission to: (a) display, copy, transfer or distribute my likeness, words, talent, actions, photographs, illustrations, and/or graphics to the extent I have made them available;  (b) to use, re-use, publish and republish the same in whole or in part, individually or in conjunction with any medium and for any purpose; (c) to copyright the same in the name of UF4A.ORG an informational website;  and (d) to use my name and my child’s name in connection therewith ONLY if I have stated my name and my child’s name in the “Background” portion of the above survey. I hereby consent to any publicity, including the use of my name and likeness to the extent I have made it available, in connection with my participation in the survey administered by UF4A.ORG. I hereby release and discharge UF4A.ORG an informational website, its officers, employees, agents and third parties from any and all claims and demands, but not limited to any claims for defamation or invasion of privacy, arising out of or in connection with the use or reproduction of such statements or images, regardless of the type of media in which they are presented.   I am of legal age and have read the foregoing and fully understand the contents thereof.
Anything else you want to say regarding medical marijuana and the treatment of your child? *
Do you know other families that would be willing to discuss the treatment of their children with cannabis? *
If they have consented to having the Foundation contacting them, please provide the best way to reach them.
What things do you most want to know about with regards to cannabis and autism (we will try to find out the answers to the most common questions that we all have) *
Are you willing to be interviewed or answer some follow up questions? *
What is your personal and/or family history with cannabis use prior to medical treatment for autism e.g. tried it when I was younger or smoke twice a week/day? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy