Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism spectrum disorders.
Intolerance of uncertainty explains why autistic youth feel anxious, so target IU in your treatment plan.
01Research in Context
What this study did
Boulter et al. (2014) asked why anxiety is so common in kids with autism.
They tested if intolerance of uncertainty (IU) is the bridge between ASD and anxiety.
Parents and kids filled out IU and anxiety forms. The team compared scores from autistic and neurotypical youth.
What they found
IU scores sat in the middle: high IU linked ASD to high anxiety.
Both parent and child reports told the same story.
IU acts like a mediator—when IU is high, anxiety rises in autistic youth.
How this fits with other research
Perihan et al. (2020) pooled 23 CBT trials and showed CBT cuts anxiety in high-functioning ASD. Christina et al. explain why CBT works: lower IU, lower anxiety.
Byiers et al. (2025) later gave caregivers the top-three-problems vote in CBT. Faster gains matched the IU-mediator idea—target what matters most, reduce IU faster.
Channell et al. (2022) took a behavior-analytic route: DRA plus stimulus fading cut anxious behavior in minimally verbal kids. Same IU pathway, different tools.
Why it matters
Next time you write an anxiety plan, add one IU probe. Ask, "What part of not knowing bothers you most?" Then pick an intervention that gives predictability—visual schedules, priming, or caregiver-chosen goals. You will be treating the engine, not just the smoke.
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02At a glance
03Original abstract
Anxiety is a problem for many children diagnosed with autism spectrum disorders (ASDs). There is a paucity of models of the cognitive processes underlying this. Intolerance of uncertainty (IU) has utility in explaining anxiety in neurotypical populations but has only recently received attention in ASD. We modelled the relationship between anxiety and IU in ASD and a typically developing comparison group, using parent and child self-report measures. Results confirmed significant relationships between IU and anxiety in children with ASD which appears to function similarly in children with and without ASD. Results were consistent with a causal model suggesting that IU mediates the relationship between ASD and anxiety. The findings confirm IU as a relevant construct in ASD.
Journal of autism and developmental disorders, 2014 · doi:10.1007/s10803-013-2001-x