As public awareness of the problem increased in the 1970's, reports of child sexual abuse increased dramatically. While blaming the victim is still common, research fails to support the notion that the child contributes to the abuse. Family factors, such as blurred role boundaries, interdependency, and other dysfunctional patterns, have been identified in incest. Preconditions for abuse include the abuser's ability to fulfill emotional and sexual needs through sexual interaction with a child and overcoming internal and external inhibitors and child resistance. The effects of the abuse have been found to vary as a function of victim age, duration and severity of abuse, use of force, and offender-victim relationship. Common symptoms include fearfulness, aggression or passivity, depression, and sexual problems. Therapists, pediatricians, protective service workers, law enforcement officials, court personnel, and legislators and policymakers have all developed their own responses to the aspects of sexual abuse they must deal with. Some approaches are oriented toward victims; others toward perpetrators. Some are therapeutic, while others are more adversarial. Increasing numbers of cases are being brought into civil and criminal courts, raising areas of potential conflict between the mental health and legal systems. Prevention will require adequate child protection policies, advocacy, and public education. 44 references.