RATIONALE: Cognitive processes and models that inform psychological treatment for
children and adolescents with Generalized Anxiety Disorder (GAD) are based on
research with adults. A systematic review of the cognitive processes associated with
GAD in children and adolescents was conducted in order to consider the relevance of
such processes to the development of GAD in this age group. The empirical study
aimed to clarify the influence of a cognitive conceptual model, the intolerance of
uncertainty model, on GAD symptoms in children and adolescents, and the
moderating influence of gender and age on these relationships.
METHOD: The literature was systematically searched and additional sources sought
for research relating to cognitive processes associated with GAD symptoms in
children and adolescents. In the empirical study 326 young people, aged II 15
years, completed self-report measures relating to GAD symptoms and cognitive
variables of the intolerance of uncertainty model.
RESULTS: Sixteen papers met inclusion criteria for the systematic review. Cognitive
processes associated with GAD included attention bias, perceptual bias of external
threat and familial relationships, perception of internal resources, anxiety sensitivity
and maladaptive coping strategies. In the empirical study, intolerance of uncertainty
and negative problem orientation were found to be predictive of GAD symptoms;
positive beliefs about worry and cognitive avoidance were found to be less important
in the prediction of such symptoms. Age and gender did not demonstrate significant
moderating effects on key relationships in this model.
CONCLUSION: A diverse range of cognitive processes were highlighted as relevant to
the possible development and maintenance of GAD in children and adolescents.
Negatively biased perceptions and tolerance of uncertainty are processes that could
be targeted in psychological interventions. From the empirical study, intolerance of
uncertainty and negative problem orientation were the components of the intolerance
of uncertainty model that appear most applicable to treatment of GAD in 11-15 year