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Climate change (CC) is projected to increase the frequency and severity of natural disturbances (wildfires, insect outbreaks, and debris flows) and shift distributions of terrestrial ecosystems on a global basis. Although such terrestrial changes may affect stream ecosystems, they have not been incorporated into predictions of stream responses to CC. Here, we introduce a conceptual framework to evaluate to what extent responses of streams to CC will be driven by not only changes in thermal and hydrologic regimes, but also alterations of terrestrial processes. We focused on forested watersheds of western North America because this region is projected to experience CC-induced alteration of terrestrial processes. This provided a backdrop for investigating interactive effects of climate and terrestrial responses on streams. Because stream responses to terrestrial processes have been well-studied in contexts largely independent of CC research, we synthesized this knowledge to demonstrate how CC-induced alterations of terrestrial ecosystems may affect streams. Our synthesis indicated that altered terrestrial processes will change terrestrial-aquatic linkages and autotrophic production, potentially yielding greater sensitivity of streams to CC than would be expected based on shifts in temperature and precipitation regime alone. Despite uncertainties that currently constrain predictions regarding stream responses to these additional pathways of change, this synthesis highlighted broader effects of CC that require additional research. Based on widespread evidence that CC is linked to changing terrestrial processes, we conclude that accurate predictions of CC effects on streams may be coupled to the accuracy of predictions for long-term changes in terrestrial ecosystems.