The current study examined indices of trauma-related symptom severity as predictors of dropout from exposure-based cognitive behavioral therapy in a sample of 99 child and adolescent trauma victims. The investigation incorporated measures of symptom severity at two time points: pretreatment and just before termination. The results indicated that a model with symptom severity measured just before termination was significantly associated with the number of attended sessions; however, a model with the symptom-severity indices measured at pretreatment was nonsignificant. In addition, a significant main effect indicated that increased avoidance behavior measured just before termination was related to fewer treatment sessions. Further analyses also suggested that higher severity of intrusion and depression measured just before termination was correlated with fewer treatment sessions. The results support the idea that more immediate distress may be related to treatment dropout. Implications for the research and practice of exposure therapy for child trauma are discussed. © 2008 Wiley Periodicals, Inc. J Clin Psychol/In Session 64: 1–14, 2008.