Intolerance of Uncertainty in ADHD & Autism

An unanswered message. A meeting without an agenda. A plan that might change.

Sometimes, waiting without knowing what will happen makes your body tense and your thoughts race. You feel unable to settle until you have an answer.

Intolerance of uncertainty (IU) describes a tendency to find the unknown particularly distressing or difficult to cope with. In ADHD and autism, this can overlap with practical difficulties around planning, sensory needs, and unpredictable demands.

In this article, we explore the signs, the links with ADHD and autism, and ways to manage uncertainty while respecting your support needs.

🧩 What is intolerance of uncertainty?

With high IU, an unanswered question can feel urgent even when you cannot resolve it. You may understand that an outcome is probably manageable and still struggle because you cannot know for sure.

Two common patterns are:

🔎 Seeking certainty: researching, checking, asking questions, or mentally rehearsing until you feel prepared.
🧊 Getting stuck: postponing decisions or struggling to act while the outcome remains unclear.

You might spend hours gathering information, then feel unable to choose. IU is a psychological concept, not a diagnosis; it can help you understand a pattern that costs time, energy, or opportunities.

🔎 Signs uncertainty may be fueling your anxiety

You might recognize:

🔁 Returning to the same question after receiving an answer.
📱 Repeatedly checking for replies, updates, or confirmation.
🌀 Replaying conversations to work out exactly what someone meant.
🧾 Preparing for increasingly unlikely possibilities.
🧷 Delaying an ordinary message because you cannot be sure it will land well.
🧱 Struggling to decide when no option guarantees the best outcome.
😬 Feeling tense, restless, or unable to concentrate while something remains unresolved.

These experiences have several possible explanations. Notice whether information helps you move forward, or briefly reassures you before the same doubt returns.

🧠 How uncertainty can interact with ADHD and autism

🧩 Autism: changes can involve real demands

For an autistic adult, an unclear plan may leave important needs unresolved:

🎧 Will the environment be painfully loud?
🗣️ Will I be expected to speak without preparation?
🔄 Will I need to change tasks or plans abruptly?
🚪 Will I be able to leave or take a break?

These details can make participation more accessible, especially after previous experiences of overload or misunderstanding.

A systematic review found a strong association between IU and anxiety in autistic people. Adult research also links sensory differences with IU. These findings do not establish a single cause of autistic anxiety. Jenkinson et al., 2020; Normansell-Mossa et al., 2021.

🧠 ADHD: uncertainty can include your own follow-through

With ADHD, uncertainty may concern whether you can carry out a plan:

⏱️ “How long will this actually take?”
📝 “Will I remember when it matters?”
🧱 “Will I be able to get started?”

Reminders, written instructions, and realistic time buffers may address these practical difficulties.

ADHD research is more limited. A small study found elevated IU in children with ADHD, but it cannot establish how common this is among adults. Gramszlo et al., 2018.

⚡ AuDHD: several needs may shape the same situation

If you have both ADHD and autism, you might be excited about an invitation while uncertain about managing the timing, conversation, and sensory environment.

Identify what is uncertain: the plan, others’ expectations, your capacity, or the outcome. Each may need a different response. AuDHD does not tell us which matters most for you.

🧭 Helpful predictability or an anxiety loop?

Needing clarity is not automatically a problem. Routines, accessibility information, and memory aids can help you function. Look at what a behavior does for you:

The same behavior can serve both purposes. Consider its flexibility and cost: does it help you finish, or become another task you cannot finish? Practical risk and anxiety can coexist.

🔁 How the uncertainty cycle keeps going

Imagine that someone has not replied to a message:

❓ You cannot tell whether they are busy or upset.
🔁 You reread the conversation and check their activity.
😮‍💨 Something you find briefly reassures you.
💭 A new possibility appears: “But what if…?”
📱 You check again.

When checking repeatedly brings relief, it can become your default response to doubt. You have fewer opportunities to discover that you can continue while the answer remains unknown.

Worry can also feel like preparation without producing a useful next step. The Centre for Clinical Interventions explains this in its guide to accepting uncertainty.

🧰 What helps with intolerance of uncertainty?

Work on two things together: reduce unnecessary uncertainty and gradually practice handling the uncertainty that remains. Choose one manageable place to begin.

📌 1. Identify what you actually need to know

Ask: “What information would change my next step?”

For an unfamiliar appointment, separate your concerns:

📝 I can clarify: where to go and what to bring.
🛠️ I can prepare: a reminder, written questions, or transport.
🌫️ I cannot know yet: precisely how the appointment will feel.

Address the practical questions, then notice what remains unknowable.

🎧 2. Make the situation manageable

If you are approaching sensory overload, reducing noise or taking a break may be the immediate priority.

Useful supports might include:

🔕 Fewer notifications and interruptions.
📝 Written information you can process at your own pace.
⏳ Extra transition time.
🚪 A clear option to pause or leave.

Keep necessary accommodations and choose challenges that fit your capacity.

✅ 3. Decide what “enough” looks like

For a routine decision, agree on a stopping point before anxiety keeps moving it:

🛒 “I’ll compare three options against my actual requirements.”
📧 “I’ll check the recipient, attachment, and meaning, then send.”
🗓️ “I’ll reconsider the plan if relevant information changes.”

Match the rule to the consequences: a casual message and an important application need different levels of checking.

If choosing itself is difficult, explore anxiety and decision avoidance in ADHD and autism.

🪜 4. Practice with a small, ordinary unknown

Try a manageable situation where you usually seek extra certainty:

📱 Leave a nonurgent message unchecked for a little longer.
🍽️ Choose between two familiar meals without comparing them again.
💬 Send a routine message after an appropriate review, allowing some uncertainty about the reply.

Notice what you expected and what happened. Did you manage the waiting? If something was awkward, could you respond?

Success can mean taking a useful step while some discomfort remains. Increase challenges gradually, keeping essential safety checks and accessibility arrangements.

🛠️ 5. Make a short coping plan

When predictions multiply, ask: “What could I do if this becomes difficult?”

For a social event, that might be:

🎧 Bring hearing protection.
🗣️ Ask for clarification if an expectation is unclear.
🚶 Take a break or leave when needed.

A brief plan gives you options. If it keeps expanding, return to the most relevant needs and one next step.

🤝 6. Ask for support with the uncertainty

You can ask for connection, practical help, and clear communication:

🫂 “Waiting is difficult. Could you keep me company for a while?”
📝 “Could you help me work out which information actually matters?”
📌 “Can we agree when we’ll next check for an update?”

If reassurance has become repetitive, agree together on a supportive response. Avoid suddenly withdrawing reassurance and leaving someone to struggle alone.

🌱 What progress can look like

Progress may include:

🔎 Recognizing when you have the information you need.
⏳ Waiting a little longer without repeatedly checking.
✅ Completing decisions with some uncertainty remaining.
🛠️ Trusting that you have options if circumstances change.
🔋 Spending less of your day trying to resolve every “what if.”

You can still need routines and clear instructions. Progress means more choice in how you respond.

❓ Frequently asked questions

Is intolerance of uncertainty the same as OCD?

No. OCD involves obsessions, compulsions, or both. IU can overlap with OCD, but difficulty with uncertainty does not establish an OCD diagnosis.

Can I enjoy novelty and still struggle with uncertainty?

Yes. A new hobby and an unclear work deadline involve different stakes, demands, and degrees of control. Uncertainty can feel different depending on the situation and available support.

Can uncertainty contribute to an autistic shutdown?

Unclear expectations can add to overwhelm. However, shutdown should not automatically be explained as IU or equated with freezing during a decision. Consider the wider demands and recovery needs.

🪞 Reflection questions

💭 Which kinds of uncertainty take the most energy from you?
🤝 What helps you feel supported when an answer is not available yet?
🌱 What would you like more space for if uncertainty occupied less of your day?

🧭 Where to go next

🔁 Understand repeated checking: Checking Behaviors in Neurodivergent Anxiety.
🧱 Explore difficulty choosing and starting: Anxiety and Decision Avoidance in ADHD & Autism.
🎧 Recognize when input exceeds capacity: What Is Sensory Overload?.
🌧️ Explore the wider topic: Neurodivergent Anxiety Learning Hub.

📚 References and further reading

🔬 Jenkinson, Milne, & Thompson (2020). The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis.
🔬 Normansell-Mossa et al. (2021). Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults.
🔬 Gramszlo et al. (2018). Intolerance of uncertainty in children with attention-deficit/hyperactivity disorder.
🔬 Dugas et al. (2022). Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder.