The subjects were compared to a control group of 42 nonabused, nonclinical girls matched for age. Of the 70 girls in the abused group, the 42 who had experienced intrafamilial abuse were also compared to the 28 who had experienced extrafamilial abuse. Evaluation of effects was based on maternal reports and importantly, given this young age group, on direct observation. Children from both abuse groups showed more evidence of distress on all measures. In particular, more sexual behavior and more internalizing problem behaviors were reported and observed. Girls who were abused by a member of their family showed some elevations in symptomatology, but generally there was not a significant difference between the two abuse groups. Poorer outcome was associated with a more noxious family environment and with repeated, more invasive abuse. The association of abuse and family characteristics that exacerbated the effects of sexual abuse on the child underscores the need for early detection and careful clinical assessment of the family as well as the child. Children who have suffered repeated or more intrusive abuse should be identified and given priority in receiving therapeutic assistance. 6 tables and 44 references