This study is the first two-site, randomized controlled treatment trial of sexually abused children that includes a sample that is large and diverse enough to be considered representative of symptomatic sexually abused children that present for treatment. Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to TF-CBT and child-centered therapy for treatment for PTSD. These children had symptoms of PTSD, with 89 percent meeting full DSM-IV PTSD diagnostic criteria. More than 90 percent of these children had experienced traumatic events in addition to sexual abuse. A series analyses of covariance was performed. The results indicate that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices. This study empirically supports the effectiveness of a short-term TF-CBT approach for multiply traumatized sexually abused children with PTSD and related difficulties. The TF-CBT approach also is superior to child-centered therapy in reducing abuse-related attributions and shame. It is effective in reducing parallel depression and parental distress about the child’s sexual abuse, and in enhancing parental support of the child and positive parenting practices. 1 figure, 2 tables, 36 references