"Intolerance of uncertainty" mediates the relationship between social profile and anxiety in both Williams syndrome and autism.
Teaching kids to handle ‘maybe’ moments can cut anxiety even before social skills improve.
01Research in Context
What this study did
Parents of 3- to young learners with autism or Williams syndrome filled out three short surveys. The forms asked about the child’s social skills, everyday anxiety, and how upset the child gets when plans change.
Researchers then used a simple stats test to see if “getting upset when plans change” explains why weaker social skills link to higher anxiety.
What they found
The intolerance of uncertainty (IU) score fully mediated the link. Once IU was in the model, social skills no longer predicted anxiety in either group.
In plain words: kids who can’t stand maybe-not-knowing feel anxious, not because they lack social skills per se, but because they hate the unknown.
How this fits with other research
Garon et al. (2018) showed that simple executive-function tasks already expose delays in preschoolers with autism. Mikle’s team adds IU as another easy-to-capture cognitive marker that sits between social profile and anxiety.
Sirao et al. (2026) found that autistic preschoolers and their play partners show weak brain-to-brain synchrony. Their social-interaction deficit and Mikle’s IU mediation both point to early, measurable risk factors, but they measure different things—one neural, one cognitive—so the papers complement, not clash.
Farley et al. (2022) reported that processing-speed and working-memory deficits in kids with mild ID plus psychiatric disorders did NOT predict behavior problems. That looks like a contradiction: why does one cognitive weakness (IU) matter while others (processing speed) do not? The difference is the outcome: E et al. looked at broad internalising/externalising symptoms; Mikle looked only at anxiety. IU seems specific to worry, not to all behavior issues.
Why it matters
If you run early-intervention sessions, add quick IU probes: “Does the child ask ‘what’s next?’ over and over?” or “Do surprises trigger meltdowns?” When the answer is yes, teach tolerance scripts, visual schedules, and “maybe” cards. Lowering IU may directly chip away at anxiety without waiting for broad social-skills gains.
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02At a glance
03Original abstract
Anxiety is the most significant mental health concern for both Williams syndrome (WS) and autism. Whilst WS and autism are characterized by some syndrome-specific social differences, less is known about cross-syndrome profiles of anxiety symptoms. Previous research has shown that Intolerance of Uncertainty (IU) is a core mechanism of anxiety maintenance for clinically anxious populations and for autistic children, adolescents, and adults. The only published study in this area for WS has shown some similar patterns-with an added emphasis on the role of sensory sensitivities-in a sample of older teens and adults (mean age = 24), with the authors highlighting the need for younger samples to consider developmental influences. Here we report a cross-syndrome, cross-sectional mediation analyses of children diagnosed with WS or autism, including data from parent surveys of 90 children with WS (n = 48) or autism (n = 42). Group differences showed higher trait levels on all measures for the autism group. Importantly, the relationship between social profile and anxiety was fully mediated by IU level for both groups. This suggests possible similar core mechanisms underlying anxiety in these conditions, and the possibility of generalized intervention approaches especially related to managing distress related to uncertainty in multiple contexts. LAY SUMMARY: Autism and Williams Syndrome share some similarities in social profile and also in anxiety traits, but there are also some key differences as well. Comparing them side-by-side at the same time improved identification of ways to reduce feelings of anxiety. We found that the intolerance of uncertainty affected the relationship between social profile and anxiety in the same way for young children diagnosed with autism or Williams syndrome, meaning that intervention approaches could be similar for both.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2554