Internalising disorders are highly prevalent emotional dysregulations during preadolescence but clinical decision-making is hampered by high heterogeneity. During this period impulsivity represents a major risk factor for psychopathological trajectories and may act on this heterogeneity given the controversial anxiety–impulsivity relationships. However, how impulsivity contributes to the heterogeneous symptomatology, neurobiology, neurocognition and clinical trajectories in preadolescent internalising disorders remains unclear.

The aim was to determine impulsivity-dependent subtypes in preadolescent internalising disorders that demonstrate distinct anxiety–impulsivity relationships, neurobiological, genetic, cognitive and clinical trajectory signatures.

We applied a data-driven strategy to determine impulsivity-related subtypes in 2430 preadolescents with internalising disorders from the Adolescent Brain Cognitive Development study. Cross-sectional and longitudinal analyses were employed to examine subtype-specific signatures of the anxiety–impulsivity relationship, brain morphology, cognition and clinical trajectory from age 10 to 12 years.

We identified two distinct subtypes of patients who internalise with comparably high anxiety yet distinguishable levels of impulsivity, i.e. enhanced (subtype 1) or decreased (subtype 2) compared with control participants. The two subtypes exhibited opposing anxiety–impulsivity relationships: higher anxiety at baseline was associated with higher lack of perseverance in subtype 1 but lower sensation seeking in subtype 2 at baseline/follow-up. Subtype 1 demonstrated thicker prefrontal and temporal cortices, and genes enriched in immune-related diseases and glutamatergic and GABAergic neurons. Subtype 1 exhibited cognitive deficits and a detrimental trajectory characterised by increasing emotional/behavioural dysregulations and suicide risks during follow-up.

Our results indicate impulsivity-dependent subtypes in preadolescent internalising disorders and unify past controversies about the anxiety–impulsivity interaction. Clinically, individuals with a high-impulsivity subtype exhibit a detrimental trajectory, thus early interventions are warranted.

内化障碍是青春期前非常普遍的情绪失调，但临床决策受到高度异质性的阻碍。在此期间，冲动是精神病理学轨迹的主要危险因素，并且考虑到有争议的焦虑-冲动关系，可能会影响这种异质性。然而，冲动如何导致青春期前内化障碍的异质症状、神经生物学、神经认知和临床轨迹仍不清楚。

目的是确定青春期前内化障碍中的冲动依赖性亚型，这些亚型表现出不同的焦虑-冲动关系、神经生物学、遗传、认知和临床轨迹特征。

我们采用数据驱动策略来确定青少年大脑认知发展研究中 2430 名患有内化障碍的青春期前青少年的冲动相关亚型。采用横断面和纵向分析来检查 10 至 12 岁的焦虑-冲动关系、大脑形态、认知和临床轨迹的亚型特异性特征。

我们确定了两种不同的患者亚型，他们内化的焦虑程度相对较高，但冲动程度却明显不同，即与对照参与者相比，冲动性增强（亚型 1）或减少（亚型 2）。这两种亚型表现出相反的焦虑-冲动关系：基线时较高的焦虑与亚型 1 中较高的缺乏毅力相关，但亚型 2 中基线/随访时的感觉寻求较低。亚型 1 表现出更厚的前额叶和颞叶皮质，以及富含免疫相关疾病以及谷氨酸能和 GABA 能神经元的基因。 1 亚型表现出认知缺陷和有害轨迹，其特征是随访期间情绪/行为失调和自杀风险增加。

我们的结果表明了青春期前内化障碍中的冲动依赖性亚型，并统一了过去关于焦虑与冲动相互作用的争议。临床上，具有高冲动亚型的个体表现出有害的轨迹，因此需要早期干预。