A 2016 study looked at the relationship between abuse and youth outcomes in relation to whether the abuse was self-reported or reported in the case file. The psycho-social outcomes looked at included both externalizing and internalizing behavior. Externalizing behavior is behavior such as acting out in disruptive ways. Internalizing behavior includes isolating, withdrawal, depression, or physical symptoms without a medical explanation.
Significantly the study found that externalizing behaviors were highest among the youth who only self-reported sexual abuse. This may be the because they did not receive the treatment for their trauma as would youth who had this information in their case file, or it could be that these youth experienced a longer period of sexual abuse and thereby had greater trauma. Internalizing behaviors were most common in the self-report only group and in the group of youth who both self-reported and the caseworker had documented the sexual abuse in the case file.
Externalizing behavior was also high for self-reported physical abuse and for those who both self-reported that abuse and a caseworker had documented it in their case file. Physical abuse had the highest level of concurrence between self-reports and case file reports, which may be that it is easy to identify physical abuse, but more difficult to identify both sexual and emotional abuse. According to the study, “Large disparities in physical abuse and neglect are also problematic. Although these forms of maltreatment may be easier for outside observers to detect compared to emotional maltreatment, there were still notable discrepancies between self-reports and case file reports. This suggests that the children and adolescents in this study may have experienced much more physical abuse and neglect than was every reported to DSS, despite having experienced sufficient maltreatment to justify out-of-home placement. These findings underscore the findings from other studies that a large number of maltreatment events may go unreported, and that emotional maltreatment in particular may be more common among youth in foster care than current reports suggest.” (p.245)