E043 · Anxiety, uncertainty & threat
Difficulty managing uncertainty
What might help when not knowing what will happen, what something means or whether something will be okay creates significant difficulty for a young person?
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Overview
Uncertainty is unavoidable. Plans change, other people's behaviour cannot always be predicted and many everyday questions do not have immediate answers.
Young people vary considerably in how manageable this feels.
For some, uncertainty creates enough distress that they try urgently to remove, control or avoid it. They may ask many questions, need detailed plans, struggle with changes, repeatedly check information, delay decisions or avoid situations when the outcome cannot be guaranteed.
The difficulty is not necessarily change itself. Sometimes the hardest part is not knowing.
Understanding this distinction can substantially change adult support.
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What this might look like
A young person might:
- repeatedly ask what is going to happen
- need very detailed information before beginning
- become distressed when adults cannot give a definite answer
- struggle with provisional plans
- repeatedly check times, arrangements or expectations
- find supply teachers or timetable changes particularly difficult
- avoid unfamiliar activities
- worry about possibilities long before an event
- find choices difficult because the outcome cannot be guaranteed
- seek rigid rules for situations that contain ambiguity
- become stuck on hypothetical questions
- find waiting for results, decisions or responses especially difficult
- repeatedly prepare for unlikely possibilities.
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Developmental expression
At this stage
Early childhood
Predictability is naturally important. Difficulty may become particularly noticeable when ordinary changes or unknowns create distress beyond what would usually be expected for the child's developmental stage.
Early childhood
Predictability is naturally important. Difficulty may become particularly noticeable when ordinary changes or unknowns create distress beyond what would usually be expected for the child's developmental stage.
Middle childhood
Increasing independence, school expectations, friendships and less predictable social situations can make uncertainty more visible.
Early adolescence
Social relationships become increasingly complex and ambiguous. Young people may become preoccupied with what others think, what messages mean or what might happen within friendships and peer groups.
Later adolescence
Education choices, examinations, employment, relationships and increasing independence introduce major uncertainties that cannot always be resolved in advance.
Choose each stage to see how the presentation and surrounding expectations may change over time.
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Strengths and differences
A strong preference for certainty can coexist with:
- careful preparation
- reliability
- attention to detail
- anticipation of potential problems
- conscientiousness
- strong planning skills
- commitment to doing things correctly.
Support should not attempt to remove these strengths.
The aim is to increase the young person's ability to function when complete certainty simply is not available.
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Top tips for support
- Provide predictability where it is reasonably possible.
- Be clear about what is known and what is not yet known.
- Do not promise certainty that adults cannot guarantee.
- Give notice of change where possible.
- Help young people develop contingency plans: “If A happens, we can do B.”
- Gradually develop capacity to manage small amounts of uncertainty rather than deliberately creating overwhelming unpredictability.
- Notice when repeated explanation has stopped providing new information.
- Validate that uncertainty can feel difficult without implying that every uncertainty must be removed.
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Things needing careful planning
There is an important balance between reasonable predictability and inadvertently making certainty a prerequisite for participation.
For some young people, repeatedly providing greater and greater certainty can become unsustainable and may strengthen the belief that uncertainty itself is unsafe.
Equally, deliberately removing helpful structure in the name of “building resilience” can create unnecessary distress.
Support should be gradual, individualised and collaborative.
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Practical support principles
Useful strategies include:
- visual schedules
- clear advance information
- explicit expectations
- planned alternatives
- distinguishing known / likely / possible / unknown
- practising manageable changes with support
- helping the young person identify what remains within their control
- reducing repetitive checking where it has become unhelpful
- developing flexible planning
- supporting regulation when answers genuinely cannot yet be known.
From understanding to support
Phoenix Atlas connections
Often useful
- visual and anticipatory supports
- environmental predictability
- anxiety-informed practice
- collaborative problem solving
- regulation approaches
Worth considering
- graded work with uncertainty
- CBT-informed approaches
- cognitive flexibility approaches
- therapeutic intervention where uncertainty substantially restricts daily life.
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Evidence and cautions
Research shows a strong association between intolerance of uncertainty and worry and anxiety in children and adolescents. A meta-analysis found substantial associations while also noting that much of the evidence available was cross-sectional. (1)
A 2026 systematic review and meta-analysis also found an association between intolerance of uncertainty and depressive symptoms in children and adolescents. It pooled cross-sectional findings and separately reviewed longitudinal studies. The association varied with measurement choice, and the review was limited to English-language studies in general-population samples. These findings do not establish causation or the effectiveness of a particular intervention. (2)
This does not mean that a young person's need for predictability should automatically be conceptualised as anxiety. Sensory, communication, executive-function and neurodevelopmental factors may also make uncertainty genuinely more demanding.
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Public evidence sources
- Intolerance of uncertainty, anxiety and worry in children and adolescents: meta-analysis — meta-analysis.
- Mares and Fuller — Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis — systematic review and meta-analysis, with a separate narrative review of longitudinal findings (2026).
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Possible explanatory lenses
Relevant possibilities include:
- anxiety
- executive functioning
- cognitive flexibility
- communication and language
- sensory processing
- previous experiences of unpredictable environments
- perfectionism
- obsessive-compulsive processes
- difficulty making decisions
- demand avoidance
- need for predictability associated with neurodevelopmental differences.
About this entry’s source
Open Beta · read the evidence notes and limitations
Source status describes the underlying material. The current site edition is Open Beta; the evidence notes and limitations remain part of the entry.
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Explore connected approaches
These Atlas entries link to this topic for a specific reading purpose. Follow the connection and its limits in the entry; it is not an automatic intervention recommendation.
- A006 · Visual and anticipatory supports
- A021 · Social narratives
- A026 · CBT-based anxiety intervention
validation is being completed by subject matter experts