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 abstractPeople 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.
Highlights
Autism spectrum disorder (ASD) is characterised by significant difficulties with social communication/ interaction and restricted, repetitive behaviours (American Psychiatric Association, 2013)
The meta-analysis will focus on the association between Intolerance of uncertainty (IoU) and anxiety, the narrative synthesis will summarise the broader collection of empirical studies investigating IoU and anxiety in autistic people, to shed further light on the association. Because it is common for data concerning autism to be obtained via a proxy, we aimed to investigate whether or not the relationship between anxiety and IoU was moderated by informant type
A metaregression analysis found a significant result that suggested the association between IoU and anxiety strengthened mildly as intelligence quotient (IQ) increased. This finding is relevant in the context of a recent meta-analysis by van Steensel and Heeman (2017), as this study found that anxiety levels were elevated in autistic children and that this difference widened as IQ increased
Summary
Autism spectrum disorder (ASD) is characterised by significant difficulties with social communication/ interaction and restricted, repetitive behaviours (American Psychiatric Association, 2013). As it is a neurodevelopmental diagnosis, difficulties are required to have been present during the individual’s early life, even though they may become more pronounced as demands and expectations increase with age. Anxiety amplifies difficulties with social functioning in this population and is predictive of poorer quality of life (van Steensel et al, 2012; White et al, 2009). As White et al (2009) argued, a more thorough understanding of the mechanism(s) underpinning anxiety in this population is required to inform targeted treatments
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