Anxiety in autistic preschool children: Phenomenology and a network analysis of correlates.
Four in ten autistic preschoolers have impairing anxiety—target intolerance of uncertainty in early interventions.
01Research in Context
What this study did
Waldron et al. (2023) asked parents about anxiety in autistic preschoolers. They used a network map to see which traits hang together.
The team found four in ten children had anxiety that got in the way of daily life.
What they found
Specific phobia was the most common fear. The biggest driver was intolerance of uncertainty.
When kids could not handle maybe-yes-maybe-no situations, anxiety spiked.
How this fits with other research
Adams et al. (2019) saw the same link in older kids. They showed that difficulty with uncertainty hurts quality of life across home, school, and play.
Adams et al. (2025) scoping review adds that sensory issues and poor sleep also travel with anxiety. The new preschool data fit right inside that bigger picture.
Llanes et al. (2020) warn that parents usually rate anxiety higher than teachers. So the 40% figure from A et al. might look smaller at school.
Why it matters
You already watch for tantrums and avoidance. Now add quick screens for intolerance of uncertainty. Ask parents: ‘Does your child melt down when plans change?’ If yes, teach flexible schedules, visual countdowns, and small daily surprises. Start early and you may cut the anxiety before it blocks learning.
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02At a glance
03Original abstract
Anxiety disorders in autistic children are associated with significant functional impairment. Few studies have examined impairing anxiety presentations in autistic preschool children (i.e., 3-5 years old). This cross-sectional study examined the phenomenology of impairing anxiety and the strongest correlates of anxiety in 75 autistic preschool children. Parents completed a diagnostic interview that assesses two anxiety types, DSM-5 anxiety disorders and impairing distinct anxiety presentations, and measures of anxiety correlates. An exploratory network analysis examined connections between anxiety and its correlates. Forty percent of children had impairing anxiety. Specific phobia followed by 'other social fear,' a type of distinct anxiety, were the most common anxiety types. Child intolerance of uncertainty (IU) was the only correlate that was associated with anxiety in a network analysis framework. Child IU linked anxiety to two other correlates, sensory over-responsivity and somatic symptoms. Findings emphasize the need for early intervention for anxiety and further research on its correlates.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2968