The purpose of this investigation is to establish the clinical effectiveness of cognitive-behavioral (CBT) and family systemic therapy (FST) for children with Post Traumatic Stress Disorder (PTSD) who have been either intra-familially or extrafamilially sexually abused. It is predicted that children sexually abused by an adult male external to the family system and receiving CBT will exhibit greater decreases in PTSD symptomatology than those extrafamially abused children receiving FST and waitlist control children. The investigators also predict greater decreases in family conflict, and disorganization and increases in family support in those intrafamilially abused children's families receiving family therapy than children in the other groups. Two hundred sexually abused children (aged 6 to 12) will serve as subjects. Half will have been abused by a non-familial male, whereas the other half will have been abused by a father figure. Each abuse and control group will be subdivided in thirds: 50 subjects will receive CBT and 50 will receive FST. Twenty five intrafamially abused children and twenty-five extrafamilially abused children will serve as a waitlist control and then be randomly assigned to CBT or FST. Experimental subjects will receive therapy for 12 weeks. The Schedule for Affective Disorders and Schizophrenia for School Aged Children will be completed at pre-, mid-, and post-treatment as a measure of PTSD. The Revised-Children's Manifest Anxiety Scale, the Traumatic Symptom Checklist, and the Fear Survey Schedule Revised with the SAFE embedded will also be completed at pre-, mid, and post treatment and after the third and ninth sessions as ongoing measures of anxiety/fear and trauma symptoms. Also at these times, children will complete the CDI, as a measure of depression. Two family observation measures, the Interaction Behavior Code, and the Five-Minute Speech Sample of Expressed Emotion will be implemented with subject and mother as measures of family conflict, disorganization, and support at pre-, mid and post treatment. Finally, variables including the frequency and duration of sexual abuse, type and severity of sexual abuse, age of onset of PTSD, parent characteristics and other types of abuse present will be considered with respect to children's response to treatment. Those children serving in the wait list control group (6 week waitlist) will undergo the above assessments at pre, 3 weeks, and 6 weeks (mid) of waitlist and then will be referred for 12 weeks treatment. All three experimental groups will be compared on dependent measures at 6 weeks and after 12 weeks.
