Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood, and the presence of comorbid externalizing and internalizing symptoms often result in severe negative long-term consequences. Multiple etiological factors contribute to the development of co-occurring symptoms. Family stability and consistency appear to be particularly important in effectively managing behavioral concerns. One important factor in producing consistency and stability is the use of routines. The current study examined how routines may be related to internalizing/externalizing symptoms in a clinical sample (N = 371) of children with ADHD (M age = 9.13, SD = 1.96; 77 % male). After controlling for child age, gender, and parental adjustment, routines predicted both internalizing and externalizing symptoms. Specific subtypes of routines including Household, Discipline, and Homework Routines were found to significantly predict symptomatology. A positive relation was found between parental and child adjustment problems; however, support for routines moderating the relation between parent and child adjustment was not supported.