Data were obtained from the archival records of 150 children and youth ages 4 to 18 who were referred to the assessment centers over a 24-month period in the late 1990's. In addition, an extensive clinical information protocol was completed by clinicians, and parents completed the Child Behavior Checklist. Cases were classified as confirmed or unconfirmed by highly experienced multidisciplinary CSA assessment teams using best practice criteria. A total of 113 cases were confirmed, and 37 were unconfirmed. Of the confirmed cases, 55 displayed clinically significant behavioral problems; 56 confirmed cases were without significant adjustment difficulties; 19 confirmed cases had violence as a central feature; and violence was not a central feature in 79 confirmed cases. As a group, the confirmed cases were largely youth who had been abused by male adults or adolescents outside the nuclear family and who were subsequently well supported by one or two parents. Poorly adjusted CSA victims had a history of victimization with coercive violent abuse, and the children who adjusted better were victims of nonviolent abuse. Victims of violent sexual abuse were more likely to have experienced penetrative abuse and to have displayed more externalizing behavioral problems. For the unconfirmed cases, the alleged victims were most often male, had single or separated parents, and had a father with a criminal history. Future research is required to clarify the referral processes associated with unconfirmed cases, the psychological mechanisms by which violent CSA and behavioral difficulties are linked, and the most appropriate method of treating youth who have experienced violent CSA. 4 tables and 30 references