The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

Abstract

The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p < 0.001. The strength of this association was comparable to meta-analyses conducted on neurotypical populations, and therefore, it was concluded intolerance of uncertainty may be an appropriate target for intervention for autistic individuals. However, conclusions were limited due to the small number of relevant studies that were available and due to issues with methodological quality. Lay abstract People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.

Development and Validation of the Autistic Depression Assessment Tool – Adult (ADAT-A) in Autistic Adults.

“…Scores range from 1-60, with higher scores indicating higher levels of intolerance of uncertainty. However, this scale although widely used in studies of autistic people, has not yet been validated in this group [37]. In the current study, Cronbach's alpha showed excellent internal consistency for the IUS-12 total scale α=.87.…”

Peer Review #1 of "Registered report: investigating a preference for certainty in conversation among autistic adults compared to dyslexic adults and the general population (v0.1)"

“…Hwang et al, 2020;Vasa et al, 2018). IU has been closely linked to anxiety in autistic people (Jenkinson et al, 2020), and also relates to core features of autism, including social difficulties, sensory sensitivities, insistence on sameness and repetitive behaviours (e.g. Hwang et al, 2020;Vasa et al, 2018;Wigham et al, 2015).…”

Commentary: Thinking flexibly about mental health and autism – a commentary on Ozsivadjian et al. (2020)

“…Originally conceptualised in relation to generalised anxiety disorder in neurotypical adulthood, IU has emerged as an important process mechanism in both the development and maintenance of anxiety in autistic children and adults. The recent meta‐analysis by Jenkinson and colleagues (Jenkinson, Milne, & Thompson, 2020) reaffirms the importance of IU as a treatment target in autism, as it is in neurotypical samples. However, recent conceptual models of the relationship between IU and anxiety in neurotypical people have suggested that a traditional therapeutic focus on mitigating fear responses in anxious individuals may be missing a more pertinent difficulty in recognising safety cues (see e.g.…”