Journal of Autism and Developmental Disorders

, Volume 47, Issue 12, pp 3949–3958 | Cite as

Intolerance of Uncertainty Predicts Anxiety Outcomes Following CBT in Youth with ASD

  • Amy Keefer
  • Nicole L. Kreiser
  • Vini Singh
  • Audrey Blakeley-Smith
  • Amie Duncan
  • Catherine Johnson
  • Laura Klinger
  • Allison Meyer
  • Judy Reaven
  • Roma A. Vasa
S.I. : Anxiety in Autism Spectrum Disorders


Modified cognitive–behavioral therapy (MCBT) has been demonstrated to reduce anxiety in youth with autism spectrum disorder (ASD). However, non-response rates are fairly high. Few studies have investigated factors associated with response. Intolerance of uncertainty (IU) is a treatment target for anxiety and worry in neurotypical populations and has been linked to anxiety and ASD. We sought to examine whether IU affects outcomes following MCBT in 43 children, ages 8–14 years, with ASD without intellectual disability. Consistent with prior data, there was a significant reduction in parent reported anxiety following MCBT. Higher levels of pre-intervention IU predicted higher anxiety and worry pre- and post-intervention. These findings suggest that targeting IU may improve outcomes following MCBT in youth with ASD and anxiety.


Autism spectrum disorders Anxiety Cognitive–behavioral therapy Intolerance of uncertainty 



Drs. Reaven, Keefer, Duncan, and Klinger and Ms. Johnson were supported by NIH Grant 4R33MH089291-03 which was awarded to Dr. Reaven. Recruitment at TEACCH Autism Program was supported by NICHD Grant U54HD079124. Dr. Vasa’s effort was supported by Autism Speaks Grant 8790.


This study was funded in part by NIH Grant #4R33MH089291-03, Autism Speaks Grant #8790, and NICHD Grant #U54HD079124.

Author Contributions

AK conceived of the study, participated in its design and coordination, and drafted the manuscript; NK participated in the design and interpretation of the data and drafting the manuscript; VS participated in the design and performed the statistical analysis; ABS participated in drafting the manuscript; AD participated in the measurement and drafting the manuscript; CJ participated in the measurement and design; LK participated in drafting the manuscript; AM participated in the measurement and drafting the manuscript; JR contributed to the interpretation of the data and drafting the manuscript; RV conceived of the study, participated in its design and drafting the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

Drs. Keefer, Kreiser, Duncan, Klinger, Meyer, and Vasa and Ms. Johnson and Ms. Singh have no conflicts of interest. Drs. Reaven and Blakeley-Smith receive royalties from Paul H. Brookes, publisher of the Facing Your Fears treatment manual.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Amy Keefer
    • 1
    • 2
  • Nicole L. Kreiser
    • 1
    • 2
  • Vini Singh
    • 1
  • Audrey Blakeley-Smith
    • 3
  • Amie Duncan
    • 4
  • Catherine Johnson
    • 1
  • Laura Klinger
    • 5
  • Allison Meyer
    • 6
  • Judy Reaven
    • 3
  • Roma A. Vasa
    • 1
    • 2
  1. 1.Center for Autism and Related DisorderKennedy Krieger InstituteBaltimoreUSA
  2. 2.Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.University of Colorado School of MedicineAuroraUSA
  4. 4.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.TEACCH Autism Program, Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.TEACCH Autism Program, Department of PsychologyUniversity of North Carolina at Chapel HillChapel HillUSA

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