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The purpose of this paper is to explore direct and moderating effects of pro-social behaviour and conduct problems on the link between limiting longstanding illness (LL-I) and negative emotional symptoms in children.

The Welsh Health Survey variables: LL-I, emotional symptoms, conduct problems, pro-social behaviour, gender, age and socio-economic status were entered into regression models to assess the relationships outlined above. Cross-sectional data from several years were combined.

In the cohort of 627 children aged 4–12 years who had LL-I, 601 (95.9 per cent) had complete data for analysis. Children with LL-I scored a mean of 1.8 points higher on negative emotional symptoms than children without LL-I, with LL-I accounting for 6 per cent of the variance in emotional symptoms in a regression model. In children with LL-I, highly pro-social children had lower levels of negative emotional symptoms compared to those with low pro-social levels (1.1 points on emotional symptoms scale, 95% CI=0.55–1.70; p<0.001). In children with LL-I, high levels of conduct problems were associated with increased negative emotional symptoms compared to those with low levels of conduct disorder (2.1 points on emotional symptoms scale, 95% CI=1.3–2.5; p<0.001).

Potential improvements include a longitudinal design, and use of multi-informant Strengths and Difficulties Questionnaire scores.

Assessment of children with LL-I could usefully include pro-social behaviours.

National policy could consider the value of promoting pro-social responses.

Emotional symptoms in children with LL-I are associated with pro-social behaviour and conduct problems, primarily as a direct effect. Pro-social interventions could promote emotional wellbeing in children with LL-I.