Child sexual abuse cases are some of the most sensitive faced by therapists because the daunting issues of a child's behavior, sexuality, appropriate development, peer interaction and family dynamics all are impacted with these crimes.

Doug Goldsmith is director of The Children's Center at the University of Utah, which hosts a therapeutic preschool for 350 children ages 3, 4 and 5. About 40 percent of these children have been physically and/or sexually abused.

The age group is — appropriately — quite interested in their own bodies, he said.

"So if a child is masturbating, it does not mean the child has been sexually abused. If the child is wetting the bed, it doesn't mean they've been sexually abused," Goldsmith said.

But committing sex acts in a way an adult would is not age-appropriate. "Committing oral sex is not something that comes naturally to a child of this age. Putting things into the vaginal area is not something that is normal," he said.

An examination of child psychology and sexual abuse also must consider the uncomfortable notion that the crimes are not always entirely unpleasant to the child.

"A part of it feels terrible to the child. It can make them scared and confused," Goldsmith said. "But a part of it can also feel good." In some cases perpetrators have created a "secret" or "special" relationship with the child.

So a young child who has been exposed to sexually inappropriate touching, behavior or pornography often becomes "eroticized," he said.

"They are preoccupied with sexual feelings," Goldsmith said. Problems increase when that child moves into elementary school years. "Many stay very excited and sexualized."

So these children, victims of abuse themselves, begin inappropriate contact with other children.

In some cases, a child who has been made to feel helpless through abuse may try to gain power and control by abusing another child. In other cases it can be an effort to create "twinship," Goldsmith explains. "If I've been abused and you've been abused, then we have something in common."

"So this is not just about finding the adult perpetrator," Goldsmith warns. "It is happening in our communities."

And it is happening between children. This sexualizing of very young children is the most daunting aspect of child sexual abuse, he says.

"This is one of the problems, and putting a stop to it is very, very difficult."

For this reason, Goldsmith encourages adults to supervise children at all times, no matter what age. No closed doors. No kids playing upstairs while Mom or Dad are downstairs.

Through counseling, child victims can learn how to soothe themselves and interact appropriately, he said. "But it's a significant, significant relearning process."