Early Intolerance of Uncertainty Predicts Childhood Anxiety and Psychopathology

Higher intolerance of uncertainty (IU) in preschool-aged children predicts greater generalized anxiety (GA) symptoms and internalizing problems across early to middle childhood, with emerging associations to externalizing behaviors, according to study results published in the Journal of Anxiety Disorders.

Researchers used a longitudinal, within-subjects observational design to evaluate whether IU in preschool-aged children predicts generalized anxiety over time and to explore the specificity of this relationship by examining associations with internalizing and externalizing symptoms from early to middle childhood. They used data from 180 children enrolled in the “Watch Them Grow” study.

Parents completed assessments of child IU (via the RULES questionnaire), generalized anxiety (via the Preschool Anxiety Scale [PAS] at age ~4 and SCAS at later time points), internalizing and externalizing behaviors (via the Health Behaviour Questionnaire [HBQ]), and their own trait anxiety (via the Trait Scale of Y2 State-Trait Anxiety Inventory [STAI]). These surveys were completed at three time points: baseline (TP1, mean child age = 4.00), approximately 2.6 years later (TP2, mean age = 6.62), and again 2.6 years after that (TP3, mean age = 9.23).

Descriptive analyses showed that IU, as measured by the RULES scale, was moderately to highly correlated across time points (TP1: M = 35.01; TP2: M = 34.38; TP3: M = 35.76), and was consistently associated with child GA, internalizing, and externalizing symptoms. GA scores were also moderately to highly correlated over time (e.g., TP1: M = 0.34; TP2: M = 0.19; TP3: M = 0.41), with correlations between RULES and GA ranging from r = .34 to r = .74.

HBQ increased over time, particularly internalizing symptoms (TP1: M = 2.68; TP3: M = 4.19), and were strongly associated with IU (r = .76 between TP1 RULES and TP1 internalizing). Parent anxiety (STAI) and marital status were also significant covariates, with two-parent households associated with lower symptom scores.

Longitudinal growth models showed that higher IU at preschool age predicted higher GA symptoms across time (Estimate = 0.58, P <.001), with a nonlinear pattern, symptoms decreased from TP1 to TP2 then slightly increased at TP3. Internalizing symptoms also increased over time (Estimate = 1.32, P <.001), especially for children with low IU scores, while those with high IU remained stably elevated. For externalizing symptoms, IU was again a significant predictor (Estimate = 0.62, P <.001), with high IU linked to a temporary rise followed by a decline, and low IU linked to stable low symptoms.

The study authors concluded, “Our findings suggest that IU is related to concurrent generalized anxiety across childhood, including in preschool-aged children.”

Study limitations include the use of parent-report questionnaires to examine IU and information regarding treatment or interventions that participants may have received was not collected.

This article originally appeared on Psychiatry Advisor