The chapter first defines child sexual abuse as "any sexual activity with a child where consent is not or cannot be given" (Berliner, 2000; Finkelhor, 1979). This includes sexual contact that is perpetrated by force or threat of force, regardless of the age of the participants, and all sexual contact between an adult and a child, regardless of whether there is deception or the child understands the sexual nature of the activity. The authors discuss the rates of sexual abuse, the characteristics of sexual abuse experiences, and the disclosing and reporting of sexual abuse. A section on the effects of sexual abuse addresses both the effects on the child victims and on adults who were sexually abused as children. The effects on children pertain to emotional distress and dysfunction, post-trauma effects, behavioral problems, interpersonal consequences, cognitive difficulties and distortions, and the course of symptoms. Effects on adults abused as children can include emotional distress, post-trauma effects, cognitive distortions, externalized emotional distress, and interpersonal difficulties. Mediating factors related to differing outcomes of child sexual abuse are also identified, including characteristics of the abuse and support from the family. The discussion of treatment issues encompasses clinical assessment, treatment for children, and treatment issues with adults who were sexually abused as children. The authors advise that prospective studies are needed that will assist in understanding the processes and experiences that mitigate or exacerbate abuse effects. In the relative absence of such research, intervention efforts should be designed to ameliorate current symptoms and promote an emotional and cognitive resolution that may improve the likelihood of a positive outcome in later years. 223 references