Examination of the Intolerance of Uncertainty Construct in Youth With Generalized Anxiety Disorder

Abstract

Intolerance of uncertainty (IU) is a dispositional characteristic reflecting negative cognitive, behavioral, and emotional reactivity in response to events or situations that are uncertain. Although closely associated with a generalized anxiety disorder (GAD) diagnosis in adulthood, IU has received little attention in youth. The goal of this study was to examine the construct in children with GAD and nonanxious children, including its incremental validity in predicting GAD severity and worry beyond anxiety. Ninety-eight children 6 to 11 years of age (51% male; 57% Caucasian) were assessed. The sample included 24 with a GAD diagnosis only (i.e., pure GAD), 36 with GAD plus at least one other disorder (i.e., comorbid GAD), and 38 healthy control children. Clinician, parent, and child reports of IU, anxiety, worry, and GAD severity were collected. Significant differences in levels of IU were found across all three groups; the highest levels in children with comorbid GAD, followed by children with pure GAD, and healthy controls. IU significantly contributed to worry but not GAD severity beyond the effects of anxiety. A significantly larger proportion of self-reported IU data were missing for younger (e.g., 6-8 years) as compared to older children, raising question about the validity of the construct in younger children. Overall findings suggest that IU is not specific to a GAD diagnosis in childhood. IU may instead serve as a broad cognitive risk factor for more severe (e.g., comorbid) forms of affective psychopathology. Future directions for research, including developmental considerations, are discussed.

Parent and child emotion and distress responses associated with parental accommodation of child anxiety symptoms

“…In addition to anxious and externalizing behaviors, child distress relating to child sensitivity to ambiguity and uncertainty may also prompt parents to accommodate. Intolerance of uncertainty, which is a cognitive vulnerability for excessive worry with a tendency to react negatively (physically, emotionally, and cognitively) to uncertain situations or events (Comer et al, 2009; Dugas, Buhr, & Ladouceur, 2004), has been linked to elevated levels of child anxiety (Comer et al, 2009), especially symptoms of generalized anxiety disorder (Cowie, Clementi, & Alfano, 2018; Read, Comer, & Kendall, 2013). Research also shows that elevated intolerance of uncertainty is related to reassurance seeking from caregivers and anxious avoidance of novel situations and/or situations in which the outcome is unknown (Comer et al, 2009; Cornacchio et al, 2018).…”

Behavioral and cognitive correlates of intolerance of uncertainty in children with and without anxiety disorders.

“…A recent examination of the specific relation between childhood GAD and IU revealed that children with GAD and another comorbid anxiety disorder had the highest levels of IU as compared to children with pure GAD or another anxiety disorder. This study also found that worry but not GAD predicted increases in IU beyond the effects of overall anxiety (Cowie et al, 2016). This result suggests that IU in childhood may be more related to underlying cognitive and emotional processes, rather than to diagnoses themselves.…”

“…Though the IUSC demonstrates acceptable reliability and validity, the measure may be difficult to complete for young children. One study found that significantly fewer six to eight-year-olds were able to complete the IUSC as compared to older children (Cowie, Clementi, & Alfano, 2016) suggesting that younger children may not be able to adequately reflect on and report their reactions to uncertainty. This again highlights the methodological issue of reliance on questionnaires to examine IU.…”

A Preliminary Investigation of Cognitive Features Associated With Worry Among African American Youth

“…Item responses are summed, with higher scores reflecting greater intolerance of uncertainty. The IUS-C's scores have demonstrated excellent internal consistency in previous samples (Cronbach's α = .95; Cowie et al, 2016). Convergent validity has been supported through correlations with related constructs, including worry, anxious symptomatology, and reassurance-seeking behavior, in a mixed sample of community and anxiety-disordered youth (i.e., children ages 7-8 and adolescents ages 16-17; Comer et al, 2009).…”

“…Indeed, the studies described above used predominately non-Hispanic White samples. Within studies on intolerance of uncertainty, the inclusion of African American participants ranged from 1.2% to 34.7% (Comer et al, 2009;Cowie, Clementi, & Alfano, 2016;Fialko et al, 2012;Kertz & Woodruff-Borden, 2013;Laugesen et al, 2003;Read, Comer, & Kendall, 2013). Although African American children made up nearly half of one child sample, between-group and within-group analyses were not conducted (Sanchez et al, 2017).…”