Objective: To date, little empirical attention has been given to the impact of preadoptive child sexual abuse (CSA) on adoption adjustment. The main objective of the present study was to investigate whether preadoptive CSA was associated with more placement moves, adoption disruption, and inconsistent parental commitment compared to adopted children without histories of CSA. Methods: Data were collected from a convenience sample of parents with adopted children (N = 117) receiving postadoption services in the state of Illinois in 2002. Thirty-three children (28.2%), nearly split evenly by gender, were reported to have histories of sexual abuse. Logistic regression was used to calculate adjusted odds ratios (AOR). Results: Preadoptive CSA was significantly associated with increased odds of four or more moves in care (AOR = 9.68; 95% CI = 3.39-27.66), adoption disruptions (AOR = 4.36; 95% CI = 1.1-16.5), and inconsistent parental commitment (AOR = 2.82; 95% CI = 1.0-7.9). Conclusion: These results suggest that children with preadoptive histories of sexual abuse are at greater risk of more complex adoption difficulties than adopted children without such histories. Practice implications: This study reinforces a small body of research suggesting that CSA profoundly complicates adoption adjustment. Findings from this study indicate that adoptive families of children with preadoptive histories of CSA need an array of preadoption and postadoption service interventions.