Although sexual abuse in childhood places the individual at risk for a variety of problems, research indicates wide variation in victims' adjustment. There is limited work that attempts to explain systematically processes by which children adjust to the trauma. Few studies have examined any theory about what causes children to be symptomatic. The proposed model suggests that sexual abuse leads to shame through the mediation of cognitive attributions about the abuse; and shame, in turn, leads to poor adjustment. Three factors -- social support, gender, and developmental period -- are hypothesized to moderate the proposed stigmatization process. Developmental and clinical research that supports the model is reviewed; specific hypotheses are offered; and the relevance of developmental psychopathology for future theory and research is discussed. Unless future research clarifies the process and circumstances whereby the experience of sexual abuse leads to poor adjustment, little progress will be made toward the development of more effective treatments. 1 figure and 136 references