Child sexual abuse can be defined as an adult's use of a minor to satisfy sexual needs. Child sexual abuse is defined as a crime within State law. Tribes may wish to create definitions within their own tribal codes to satisfy their community and law enforcement standards. Most cases of child sexual abuse develop gradually over time, and the offender is known to the child in 90 percent of cases. Sexual attraction toward children, a need to feel sexually able, stress, and a history of childhood sexual abuse often are found among perpetrators. Family factors may include geographic or social isolation, stress or dysfunction, unrealistic expectations, rigid roles, alcoholism, and/or poor communication. Some social and cultural factors also may contribute. American Indians may have special problems in seeking appropriate legal and social services that are related to denial, distrust of legal and other authorities, and jurisdictional issues. Indicators of abuse may include regression, withdrawal, sudden behavior changes, phobias, sleep disturbances, aggression, depression, school problems, and sexually inappropriate behaviors. The effects of abuse on the child are related to the type and duration of abuse, its identification, the relationship of the abuser, and the treatment provided. Following disclosure of abuse, efforts should be made to ensure the child's safety and appropriate treatment should be sought. Communities must make it known that child sexual abuse will not be tolerated; provide effective child and adult education; and develop coordinated policies, procedures, and services. 1 table.