Generalized anxiety disorder (GAD) is a condition whose main feature is chronic, excessive and uncontrollable worrying, occurring most of the time. Although most of the research on worry has been conducted with adults, studies suggest that children and adolescents can also struggle with worry. GAD during childhood significantly increases the risk of developing other anxiety disorders as well as depression during adolescence, so understanding the factors that give rise to chronic worry in very young people could shed light on ways to intervene in the early years. With this in mind, multiple strands of research have explored different environmental factors (for example, difficult life events), personality factors (for example, the way people react to, and make sense of ambiguity) as well as biological factors (for example, genetics) (Murray, Cresswell, & Cooper, 2009).

Emerging research shows that a theory of GAD that was developed initially to explain adult worry, also seems relevant to younger people. The Intolerance of Uncertainty framework, developed by Michel Dugas, Mark Freeston and colleagues suggests that GAD is maintained by the presence of four factors: (1) a low tolerance for uncertainty, (2) unhelpful beliefs about worry, (3) a perception of problems as insurmountable and (4) avoidant coping (for example, engaging in habitual efforts to avoid thinking about upsetting things, like scary situations that may happen in the future). A low tolerance for uncertainty in particular has been implicated in child and adolescent worry. People who are intolerant of uncertainty tend to interpret ambiguous or uncertain information as threatening and unacceptable and will go to great lengths to reduce feelings of uncertainty. Take the example of a student who has just finished writing an exam. While most students may be eager to know their grade, someone who is intolerant of uncertainty may find the uncertainty of the situation especially distressing and end up worrying about their results, assuming the worst about their performance. Such an individual might spend a lot of time online checking for their grade or might email their professor soon after the exam out of an urgent “need to know.”
Past research in IU has examined its relationship with worry in children and adolescents. A study conducted in 2012 by Fialko, Bolton, and Perrin demonstrated that IU strongly predicted an increase in worry frequency in adolescents (aged 13-19), with an even stronger relationship observed in children (aged 13-19). A later study by Kertz and Woodruff-Borden (2012) found IU to be linked to clinical levels of worry in a sample of children between the ages of 8 and 12 years old.

Furthermore, a study conducted by Michel Dugas and colleagues (2012) aimed to explore the link between IU and worry in adolescents. This unique study was conducted over a period of five years with 338 high school students who were of an average age of 12.5 years when they first enrolled. Participants were asked to complete surveys twice a year on their level of worry, intolerance of uncertainty, and fear of anxiety. Results indicated that IU and worry were distinctly related to each other. Specifically, greater levels of IU lead to greater levels of worry over time, and vice versa.

So, how can one break this cycle? A pilot study by Payne, Bolton, and Perrin (2011) aimed to find out if cognitive therapy could be beneficial for adolescents with GAD. IU was among the factors targeted in the therapy. The therapy consisted of multiple stages which incorporated education about worry as well as a teaching component where the teens participated in exercises and were taught skills to help manage their worry. The treatment focused on training participants to become more aware of their worry, helping them alter their unhelpful beliefs about worry, guiding them to reduce avoidance of uncertainty, and ensuring they were taught skills to prevent a relapse of the worry. The vast majority of the study participants (15 out of 16) either had significant improvements in their symptoms or lost their diagnosis altogether, suggesting that the therapy was an effective one. Further research into GAD and its presentation in youth can help us continue to find ways to help children and teens who struggle with chronic worry.