I sent a photo of the picture Doodicus drew to Dr. Rita. Below is his response. Thank you all for your previous comments, because you each touched upon a point that the doctor echoed in his email:
I appreciate the note—I am glad you told me about this. It can be terribly scary for parents, and terribly difficult to know how to proceed.
First, I should say that this is not an uncommon before [sic?] for kids. As far as risk assessment goes, the behaviors you described do not indicate a significant degree of risk (for instance, he is not discussing means of hurting himself that he has access to, he is not acting on these statements, etc). Many kids make these kinds of statement and draw these kinds of pictures without appreciating the implications. This behavior is especially common among kids with ADHD, because a certain degree of emotional dysregulation goes along with the hyperactive and inattentive symptoms.
In terms of management, I would recommend several interventions:
1) Convey to [Dood] that these statements are serious, and will be handled as such. They are powerful words, and not to be taken lightly.
2) Identify the emotions [Dood] is experiencing in relation to these thoughts. He will have difficulty with this, so will need help. For instance, what he is really saying is that he is frustrated, angry, sad that he is not getting what he wants, etc.
3) Emphasize your concern and love for [Dood], and the reaction you have to him making these statements (this has a duel benefit, both modeling appropriate emotional expression and explicitly stating how much you care about him). Let him know that you are worried and scared, regardless of whether he meant it or not. He said it, and you believe what he says, and so you are scared, worried, etc.
4) Consider a natural and logical consequence, such as restricting access to the sources of the imagery he used. For example, where does [Dood] see bombs and missiles? If that is in video games, letting [Dood] know that you are really worried about him and want to keep him safe. Taking a break from those images might help. (the logic on this one will likely be transparent to you, essentially, saying these things will result in losing video games. However, were [Dood] older and his threats more serious, i.e., I am going to drive my car into something or take all the pills in the cabinet, we would talk about doing the same thing—restricting access to means and methods. Limiting contact to imagery is a downward extension, with the added benefit of introducing a cost to these kinds of statements.
5) Normalize the feelings. Letting [Dood] know that he can be angry, sad, frustrated, desperate, uncomfortable, lonely, etc., and these are perfectly fine feelings to share with mom and dad. You can hear that he is having those feelings. Of course, it will not change bedtime, shower location, or other environmental matters, but it is important to you that he shares these emotions and you can help him manage them.
6) I know this is a tall order, but try to take as much steam/pressure/heat out of the situation from the beginning. If you see him getting agitated, or feel yourself getting agitated, it is time to take a break. This is especially difficult in urgent situations, but also especially important. You, and potentially [Dood], will already be somewhat upset because you have to move quickly, so the fire is already stoked. You don’t want to add to it. He might say something inappropriate or loud or disrespectful. Wait to discuss consequences until you have the time, energy, calm head to implement it.