(PS3-B32) The Relationships Between the Subcomponents of Intolerance of Uncertainty and Symptoms of Autism and Anxiety

There is growing interest in the relationship between autism spectrum disorder (ASD), anxiety, and intolerance of uncertainty (IU). IU is a transdiagnostic feature of anxiety, and has been found to be associated with comorbid anxiety symptoms in youth with ASD (Boulter, 2014). IU is likely a multi-faceted construct (Comer et al., 2009; Wong & Caporino, 2022), but it is unclear if the facets differ between youth with anxiety, ASD, or both. Also, more research is needed to test if measures capture IU specifically or other features associated with ASD, like behavioral rigidity. Using the Youth Intolerance of Uncertainty – Parent Report (YIU-PR; Wong & Caporino, 2022), we hypothesized that youth with elevated anxiety symptoms (ANX) and comorbid anxiety and ASD symptoms (ANX+AS) would have higher YIU-PR subscale scores compared to those with only elevated ASD symptoms (AS). We also examined the associations between IU and ASD symptoms, depending on youth IU measure.        

Participants were caregivers (N = 731; 61.7% female; 73.2% non-Hispanic White) of youth ages 6 to 17 years recruited through Amazon Mechanical Turk. They completed parent-report measures of youth anxiety symptoms, ASD symptoms, and IU as well as a demographic questionnaire. We used parametric and non-parametric ANOVAs to test for group differences in YIU-PR subscale scores, and correlations to examine the associations between youth IU measures and ASD symptoms.

There were significant differences between the ANX, AS, and ANX+AS groups on the four YIU-PR subscales: 1) Difficulty Tolerating Waiting Periods (F(2, 204) = 21.27, p < .001), 2) Doubting and Reassurance Seeking (H(2) = 20.82, p < .001), 3) Overestimation of Negative Events (H(2) = 29.29, p < .001), and 4) Physical and Behavioral Responses (F(2, 204) = 26.19, p < .001). Post-hoc analyses showed that compared to the AS group, the ANX and ANX+AS groups had significantly greater difficulty tolerating waiting periods (M_ANX = 30.44, SD = 6.60; M_ANX+AS = 33. 08, SD = 5.91; M_AS = 24.97, SD = 7.79), doubting and reassurance seeking behaviors (U_ANX = 1914 p</em> < .001; U_ANX+AS = 820, p < .001), overestimation of negative events (U_ANX = 17002.50, p < .001; U_ANX+ASD = 697, p < .001), and physical and behavioral responses to uncertainty (M_ANX = 16.97, SD = 3.61; M_ANX+ASD = 17.46, SD = 4.29; M_AS = 12.81, SD = 4.11). The ANX group did not significantly differ from the ANX+ASD group on the YIU-PR subscales. Only the Responses to Uncertainty and Low Environmental Structure measure (Sanchez et al., 2017) had a significant positive association with ASD symptoms in young children (r = .20, p = .044); the YIU-PR and the Intolerance of Uncertainty Scale for Children (Comer et al., 2009) were not significantly correlated with ASD symptoms in children and adolescents.

These findings suggest that dimensions of IU are experienced similarly by youth with elevated anxiety with and without comorbid ASD symptoms, and that the YIU-PR is not merely tapping ASD concerns. IU may be an important intervention target in children with comorbid ASD and anxiety. This is pertinent as mental health professionals bolster youth psychological well-being following great uncertainty during the COVID-19 pandemic (Lee, 2020).