Mexican American students are the fastest growing group in U.S. public schools. There is a growing body of research indicating that Mexican American families underutilize mental health services and are more likely to drop out of care prematurely when they do seek help. These findings may indicate that our health care system is not providing ethnic minorities with culturally competent care. Although cognitive-behavioral interventions are considered to be evidence-based treatments for child anxiety disorders, previous protocols have not taken cultural factors into account. This article discusses how to adapt cognitive-behavioral therapy (CBT) for Mexican American students with anxiety disorders. Working within the Psychotherapy Adaptation and Modification Framework (PAMF), this article offers adaptation principles that may guide school psychologists in implementing CBT strategies when working with Mexican American youth and their families. A case study is provided illustrating how cultural modifications of CBT can lead to positive outcomes for Mexican American students.