Behavioral and cognitive correlates of intolerance of uncertainty in children with and without anxiety disorders.

Intolerance of Uncertainty (IU) has long been identified as a proximal risk factor for the development of anxiety disorders, and more recently has been implicated in the development of emotional disorders broadly. However, little is known about how IU and psychopathology symptoms relate, limiting the degree to which IU can be identified prior to the development of emotional disorders and targeted during the intervention of disorder symptoms. The current study reviews several areas of literature to inform a model by which IU impacts anxiety symptoms. First, uncertainty processing and the development of uncertainty processing in childhood are reviewed. Next, IU is reviewed and model of the impact of IU on uncertainty processing is proposed. Finally, childhood IU is reviewed and current gaps in the childhood IU literature are identified. The current study hypothesized that IU contributes to uncertainty avoidance, which is reflected by cognitive and behavioral processes associated with decision-making under uncertainty. Specifically, this study tested the hypothesis that children with higher IU demonstrate less efficient information processing and decision-making, particularly in the presence of ambiguous information. Further, this study tested the hypotheses that the relation between IU and disorder symptoms would be moderate by individual differences in higher order cognitive control processes implicated in decision-making. The study recruited 47 children, 23 with anxiety disorders and 24 without, to test these hypotheses. Children completed a decision-making computer task and children and their parents completed questionnaires. Overall, the results partially supported the study hypotheses. IU predicted greater reaction time (RT) during the task but RT was not greater in the presence of ambiguous, as compared to neutral or threatening, stimuli for children with high IU. IU predicted greater distraction from the task target and distraction was increased in the presence of ambiguous stimuli for children with high IU. Accuracy was not related to IU. Exploratory analyses indicated that children with high IU demonstrated greater RT variability compared to children with low IU, and greater distractibility in earlier, compared to later, task trials. Results are discussed in terms of theoretical and clinical implications for future study and intervention of IU

Partnering With Stakeholders to Inform the Co-Design of a Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease

Input from diverse stakeholders is critical to the process of designing healthcare interventions. This study applied a novel mixed-methods, stakeholder-engaged approach to co-design a psychosocial intervention for mothers expecting a baby with congenital heart disease (CHD) and their partners to promote family wellbeing. The research team included parents and clinicians from 8 health systems. Participants were 41 diverse parents of children with prenatally diagnosed CHD across the 8 health systems. Qualitative data were collected through online crowdsourcing and quantitative data were collected through electronic surveys to inform intervention co-design. Phases of intervention co-design were: (I) Engage stakeholders in selection of intervention goals/outcomes; (II) Engage stakeholders in selection of intervention elements; (III) Obtain stakeholder input to increase intervention uptake/utility; (IV) Obtain stakeholder input on aspects of intervention design; and (V) Obtain stakeholder input on selection of outcome measures. Parent participants anticipated the resulting intervention, HEARTPrep, would be acceptable, useful, and feasible for parents expecting a baby with CHD. This model of intervention co-design could be used for the development of healthcare interventions across chronic diseases