Emotional dysregulation and uncertainty intolerance as transdiagnostic mediators of anxiety in adults with autism spectrum disorders and intellectual disability.

Costa et al. (2020) asked why anxiety is so common in adults who have both autism and intellectual disability. They tested two possible bridges: difficulty handling uncertainty and trouble managing emotions. The team used surveys and statistics to see if these bridges carry the anxiety load.

Both bridges held. When adults with ASD and ID feel more uncertainty or get emotionally overwhelmed, their anxiety rises. The stats showed these two factors explain the autism-anxiety link in this group.

Sáez-Suanes et al. (2023) built on the same idea but added gender. They found the emotion bridge is strongest for women with ASD and ID, so clinicians should teach regulation skills first when the client is female.

Soto et al. (2024) looked at kids and teens instead of adults. They saw anxiety drove repetitive and self-injurious behaviors, while emotion dysregulation played a smaller role. Age and speaking ability shift which bridge matters most.

Bitsika et al. (2020) studied autistic boys without ID. In that group, sensory avoiding—especially sound sensitivity—was the main bridge, not uncertainty or emotion. The mediator changes when ID is absent and the senses are on high alert.

If you serve adults with both autism and ID, screen for how they handle unknown situations and emotional storms. Teach concrete uncertainty rules like “first-then” cards and give labeled emotion choices. When the client is a woman, double-down on emotion-regulation drills. When the client is a non-speaking youth, watch for anxiety-driven self-harm and treat the anxiety first, not just the behavior.