Prior trauma is often present in adults but appears to be essential in the background of a sexually reactive child. Children with effective social skills are less likely to offend sexually because they usually have a more extensive social network from which they can draw support. Some children relate relatively well on a superficial basis but still feel lonely due to problems in maintaining close friends. Likewise, a child with poor social skills may have developed one or more intimate relationships. Although children tend to be more impulsive than adults, sexually reactive children appear to have more difficulty with impulse control than their peers. Children's lack of accountability refers to an overall tendency to deny personal responsibility for their actions. Finkelhor describes the following preconditions as being critical to sexual molestation: motivation to sexually abuse, factors predisposing to overcoming internal inhibitors, factors predisposing to overcoming external inhibitors, and factors predisposing to overcome a child's resistance. The authors present a "trauma outcome process," an approach that differentiates responses to trauma as self-victimizing, assaultive, and/or healthy coping and that has implications for treatment. They stress that victims of sexual abuse make choices in their emotional and behavioral responses to trauma. 26 references