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Parent attachment avoidance was related to increased parent cortisol levels in the clinic and increased child cortisol levels at home. Parent and child cortisol levels had a strong, positive relationship in the clinic but not at home. We did not observe a difference between cortisol levels in children or parents in the clinic or at home. We concluded that this protocol is feasible and provide suggestions for future research. Stress physiology in pediatric occupational therapy clients should be considered within the context of the family system. Fami