The Impact of Self-Reported Health Factors on Behavioural Difficulties in School-Aged Children: Findings from the HAPPEN Pan-Wales Cohort Using Data Linkage

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Abstract This study aimed to examine factors associated with behavioural difficulties among school-aged children (aged 7 -11 years) using self-reported survey data linked to education data from a national cohort study of over 50,000 children (the HAPPEN national cohort) in Wales, UK, between 2014 and 2024. Data include self-reported health and wellbeing linked to Additional Learning Needs (ALN) status collected from education data in Wales. Measures included self-reported time spent on screens, frequency of sugary snack, fizzy drink and takeaway food consumption, physical activity levels, sleep duration and behavioural difficulties (as measured by the Me and My Feelings Survey). Associations were analysed using descriptive trends, K-means cluster analysis and multivariate regression modelling. Findings showed a rise in behavioural difficulties during and after the Covid-19 pandemic, which are now improving in Wales. Cluster analysis identified that children with poor sleep and high consumption of takeaway foods and fizzy drinks dietary habits had the highest levels of behavioural difficulties, a trend that remained significant after adjusting for all potential confounders. Physical activity associated with reduced behavioural difficulties, with 5–6 days of activity associated with the lowest difficulty scores. These findings suggest that behavioural difficulty is driven by health behaviours especially sleep and diet rather than single factors. The results highlight the need for integrated public health approaches that address dietary quality and sleep hygiene rather than focusing on individual behaviours in isolation. Promoting balanced daily activity patterns, establishing good sleep routines, improving food environments and building movement into the school day may have important benefits for children’s behaviour.

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