Children frequently do not tell anyone that they are being sexually abused. Even if the child has a close and trusting relationship with a parent and the abuse is by someone outside the family, the child may keep the abuse a secret out of shame, confusion, fear of retribution by the abuser or, if the child is young enough, lack of understanding about what is happening. In these cases, clues may be found in the behavior of the child. There may be a marked change in the child’s behavior, including a sudden onset of anxiety, depression, social withdrawal, reduced self-esteem, or sleep disturbances. A previously well-adjusted child may suddenly start acting truant, perform poorly in school or lose, or gain a good deal of weight. Unusual or predatory sexual behavior in the child can be another clue that the child has experienced sexual abuse. A sudden fear or aversion to a particular adult may also be a clue. Of course, behavioral changes like these can be due to many other causes besides sexual abuse. There is no need to assume a child who has developed some emotional problems has necessarily been sexually abused. Nonetheless, it is important to recognize that children cannot always verbalize that they have been abused and may express their suffering through marked changes in their behavior.