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Research on sexual homicide of child victims is scarce. Studies focusing on the lethal outcome in sexual crimes involving adult victims suggest that those offenders who end up killing their victims present both specific individual and crimecommission process characteristics. Nevertheless, recent studies indicate that findings with adult victims may not adequately explain the lethal outcome in sexual crimes of children. The purpose of this study is to identify specific combination of offenders, victims and crime-commission process factors associated with a lethal outcome in child sexual abuse. Participants: This study compares and analyzes the characteristics of 646 cases of extrafamilial child abuses with 136 cases of sexual homicide involving children. Bivariate analyses and sequential binomial regression analyses were conducted to identify variables associated with crime outcome. Finally, conjunctive analyses were used to identify combinations of factors that are the most likely associated with the lethal outcome. Results: Results indicate that both offenders and crime-commission process characteristics are strongly associated with sexual homicides of children. Offenders who sexually murder children are extremely instrumental and opportunistic. They are also more likely to have a life history characterized by the manifestation of diverse antisocial conducts. The findings of this study provide important theoretical and practical implications for crime investigations, prevention, and offenders' management. [ABSTRACT FROM AUTHOR]