Addressing Intolerance of Uncertainty in Anxious Young People with Autism Spectrum Disorder

Thursday, May 11, 2017: 5:30 PM-7:00 PM
Golden Gate Ballroom (Marriott Marquis Hotel)
J. Rodgers1, M. Freeston2, E. Honey3, A. Hodgson4, K. Shields4 and C. Wright5, (1)Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, United Kingdom, (2)Psychology, Newcastle University, Newcastle, United Kingdom, (3)Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UNITED KINGDOM, (4)Newcastle University, Newcastle, United Kingdom, (5)Northumbria Healthcare, Newcastle, United Kingdom

Anxiety is a significant problem for many children with autism spectrum disorder (ASD), who frequently present with multiple anxiety disorders concurrently. Treatments targeting underlying anxiety mechanisms may therefore be most efficacious. Over the last five years our group has worked towards providing a theoretically informed formulation of anxiety in ASD. This work has focused on a consideration of a well-established model of anxiety: the Intolerance of Uncertainty Model. Intolerance of uncertainty (IU) is a ‘broad dispositional risk factor for the development and maintenance of clinically significant anxiety’ in neurotypical populations. The concept of IU has utility not only to theoretically inform understanding of the factors underlying the development and maintenance of anxiety, but has also been shown to be a beneficial target for treatment. Intervention studies with neurotypical individuals with high IU provide evidence that reduction of IU is associated with reduction in anxiety. Cognitive behavioural treatments for clinically anxious patients have been developed which emphasise treating the cognitive process rather than the cognitive content of anxiety, specifically by aiming to increase patients’ tolerance for uncertainty and thereby achieving more sustainable change. Over the past five years research has investigated the relevance of IU to anxiety in ASD. This work indicates that IU is a key construct in anxiety in children and adolescents with ASD, which may account for the increased vulnerability to a range of anxiety disorders in this population.


Our objective was to develop and evaluate the feasibility and acceptability of a parent mediated, group intervention targeting IU for young people with ASD.


Phase One: Parent focus groups informed the development of the materials and trainers’ manual. An eight week manualised intervention programme was developed; CUES, Coping with Uncertainty in Everyday Situations©. The treatment provides parents of children with ASD, with effective strategies to reduce their child’s IU in everyday situations.

Phase Two: The programme was delivered to 11 parents of children with ASD, aged between 8 and 15 years across three treatment groups, two recruited via a research data base and one via clinical services. The intervention included in-session activities and homework tasks, which focus on increasing tolerance of uncertain situations. Baseline and outcome measures assessing child and parent anxiety and IU were completed. Individual follow-up interviews were undertaken with parents to ascertain acceptability and feasibility.

Results:  Data regarding retention, acceptability and feasibility indicate that the parents who participated valued the programme. Preliminary data relating to effect size analyses of outcome measures indicate that the programme has promise as a treatment option of young people with ASD and IU. Parents reported a reduction in their own and their child’s intolerance of uncertainty and anxiety subsequent to participation on the programme.


The findings indicate that parents of young people with ASD view an intervention which focuses on intolerance of uncertainty to be valid and meaningful. The data available indicate that CUES may have promise as a targeted package to assist young people with ASD and their families to manage their responses to uncertainty.