May 28, 2025 • 32 mins
In this powerful episode of the Mothers of Boys Survival Guide, we talk with licensed clinical psychologist Adam Iacarino about how moms can support their sons' mental health, build resilience, and foster independence. From preparing boys for therapy to navigating big transitions and promoting confidence through volunteering, Adam offers real talk and actionable insights every parent needs to hear.
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Episode Transcript
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(00:01):
Raising Emotionally Resilient Boys and Young Men.
Welcome back to the Mothers of Boys Survival Guide, the podcast where we
talk about raising boys and everything that comes with it. I'm Cheryl Bohn,
and with me today is co-host and author Suzy Shaw.
Hello Cheryl, and glad you all are joining us, Mothers of Boys.
(00:24):
Well today's episode tackles some things that moms quietly worry about - our sons
mental health? Are they just moody? Or is something deeper going on? Why do they shut
us out when we try to help? How do we teach them to express their feelings? What is the appropriate
level of freedom to give? And how do we know when it's time to get professional support?
(00:46):
The truth is, teen boys are struggling more than we think. Anxiety, depression, anger,
and difficulty expressing their feelings. How is masculinity even defined for boys today?
This is a conversation every mother of boys needs to hear. As a mom,
you're pretty good at triage and identifying the right bandage for the current scrape or injury,
(01:11):
but the signs of mental health issues are sometimes much harder to identify.
Well in this episode, we're talking to a licensed mental health counselor who
specializes in advising and guiding parents and young people as they develop and mature. Our guest
today is Adam Iacarino, a licensed clinical psychologist with expertise in depression,
(01:35):
anxiety, spectrum disorders, and ADHD. Adam founded Community Mental Health Associates
in 2010 and Elevation Therapy Group in 2021. He provides regular consultation to families,
psychiatric hospitals, and public and private schools. Welcome Adam.
(01:55):
Hello. Thank you so much for having me.
We really appreciate you joining us and I know I have a great deal of respect
and appreciation for mental health professionals and there were several
periods during our boys' lives growing up that we found professionals just incredibly
(02:18):
helpful in guiding us and guiding the boys. Can we start from the beginning,
Adam? Can you describe some of the warning signs and when we should go find somebody like you?
Absolutely. Well, first of all, I thank you both for doing this podcast because,
so 2010, so November will be 15 years and I can just see every mother that I've worked with,
(02:46):
they make the same face when they bring their son in, whatever age, and they all
make a similar face which was like, what the hell was that? What do I do? What is happening?
So this is such a needed thing you guys are doing. So warning signs for sure.
So I want to avoid any kind of general sweeping statements and one size fits
(03:08):
all. So I like frameworks. So a warning sign would be anything maladaptive that
has an impact on the framework of his life. So we'll say, we use a framework
called PEPSI (Person - Emotional - Physical - Social- Intellectual). So a very, very smart
psychologist once, he mentored me, he was just like a father to me, he taught me about Pepsi.
(03:28):
And PEPSI's not the drink?
Pepsi's not the drink, not this time. PEPSI equals the four sides of the young man,
emotional, physical, social, intellectual. So if there are thoughts or behaviors or
even motivations that are impacting one of those four sides of himself negatively,
(03:53):
then it's time for concern and maybe reach out to a mental health professional.
So it could be thoughts. He has plans to go out Saturday night with friends,
but he can't, he doesn't, he says he doesn't want to,
but he can't really do it because there are certain ways of thinking
that are impacting the way he views himself or how he assimilates things into his life.
(04:19):
Can you say those again?
So PEPSI is the person, the overall person is emotional, physical, social, and intellectual.
So we can fit school, we can fit friends, we can fit extracurriculars, anything active, sports,
things like that. So if anything's being impacted where, “man, this is the third week in a row,
(04:41):
he's mispracticed, what's going on with this guy?” We got to dig a little deeper. Rather
than he's just being a little weird, being a little quirky, had a few nights where he
couldn't really sleep, things like that. Not mental health concerns right off the
bat. If it's not impacting things, well yeah, I was tired, but I still did what I had to do.
So the old DSM (Diagnostic and Statistical Manual of Mental Disorders), the fifth axis was
(05:01):
global impact of functioning. How functional, how is this disorder,
if it is a disorder, how is this disorder impacting his everyday life?
So I mean, something could be mild that we still would want to look into. So on a way of,
we want to limit the suffering, limit any kind of emotional distress. That's
a thing. If he says like, “I'm sad, I'm still doing what I got to do,
(05:24):
but I'm sad about something.” Then, of course, then we want to reach out to a
counselor as well. But in terms of, you don't know anything other than what you're seeing.
But how can you, how do you differentiate? I think there's definitely mood swings when
they become teenagers or there's different things. How can you differentiate between
typical teenage behavior and something that would be a mental health concern?
(05:48):
Well, if there's mood swings and he's still attending school, still eating,
still doing these four parts of himself, they're still intact. So we can still function through the
mood swings and we can do things in a bad, the bad moods aren't so severe that we're not functioning.
Okay.
I mean, we can, we can pretty much bank on mood swings, boys are going to be just as moody as
(06:15):
anything, you know? So it's whether we show it or not is going to be the deciding factor. That's why
I like this podcast so much, because it's like, what a warning signs that we have in our head,
these tools that we have in our back pocket so we know what to look for. You
know what I mean? Because they're not always going to come out and be like,
I had an emotionally trying math test today.One of the things for me that was really important
(06:42):
was trying to build trust and building trust with a teenager is, was difficult,
it definitely ebbed and flowed in one minute, you're their best friend and the next minute
they hate you and the door's getting slammed. And I mean, the, you know, my two boys in the book,
(07:04):
I call them Earnest and Exuberance and I had one that when he was really upset, he would spin down
inside himself and get super quiet. And then the other one would spin outward and there was no,
you know, there was no question as to whether he was upset or not, because he was just loud.
(07:29):
So you know, what can a parent do to ensure that their child,
you know, knows and can trust and can express their feelings.
What I've learned is it's less of they hate you and more of they don't have the vocabulary.
(07:50):
So slamming a door is kind of by default, just more instinctual and it just feels right. I have
a surge of whatever adrenaline, I'm very angry. So slamming the door seems like the right thing
to do. And it's, I mean, it's unrefined, of course, but that's kind of the thing.
So actions don't always equal what's going on inside, which is always a good thing. So if
(08:11):
you hear the door slam, you're like, man, that's really something going on that's very severe. When
a lot of times it's just a moment. And sometimes it's like 10 minutes later, he's back to normal.
So once that like, that outer brain, the logic kind of kicks back in and they're like, dude,
it wasn't that big of a deal, you know, but in the moment they'll scream and kind of, because
they don't, a lot of them don't have the vocabulary. So a lot of times in therapy,
(08:33):
it's a lot of like feelings, words and communication techniques of like stopping,
forming a sentence, which actually buys them some time, things like that.
If you need to do 20 pushups, that's cool, to get like adrenaline out or something.
How do we get them to feel comfortable speaking to us when something's bothering them? You know,
a lot of times kids are afraid they're going to get in trouble or they're afraid maybe like
(08:58):
we want to build that trust and then get them to feel comfortable. Do you have any advice for that?
Of course. I think the worst thing to do would be practice a fire drill in the fire. So if the only
time you two ever speak is when you're expecting him to share hard feelings, that's a mistake. We
have to set a rapport. There needs to be some kind of rapport relationship beforehand that
(09:23):
we've talked about 10 funny things so the door is open to talk about this one serious thing.
So sometimes I'll talk to parents and they're like, well,
he just never talks to us about anything. I'm like, when was the last time you guys
did anything fun together? So it's like, well, if I never talked to somebody and
then I had a tough day, I wouldn't go to them. So you need to have that rapport.
(09:45):
And, you know, I kind of faced this in therapy on the first few sessions because I've never met this
person. It's very clear. Like it's clear that they don't want to just come in bursting with personal
information about vulnerabilities and things like that. So I first need to build that rapport. And
I'll even, you know, self disclose some things if that helps back and forth. So sometimes moms
(10:06):
can share, you know, I've had a tough day the other day, too. And you can tell them about it.
You know, so and also, I think less, the less formal, the better. It's more like a rolling
conversation. Kind of the door is always open. So the ebb and flow kind of creates this idea that,
well, I need I need some kind of predictable pattern. I need some kind of schedule to
(10:31):
know when things are happening, when in reality, it's really just going to come
up whenever we just have to have the door open. He needs to know it's open whenever.
Can you suggest some coping mechanisms when when the boys are going through a stressful time?
Sure. I think a lot of teenage are we are we're focused on more
(10:53):
like a teenage kind of sit or just all like zero to 18 or.
Well, what age do you typically find boys start to come to see you?
Early high school. So 14 to like early 20s.
Well, so coping for a five year old is going to look different
than an 18 year old. So coping for a five year old is like, you know,
color some stuff and give it nine minutes and we're a different person. Right.
(11:18):
A 15 year old. There tends to be overthinking. So things to giving that monkey brain something else
to play with is typically the coping mechanism that works the best, meaning I'm exercising,
I'm drawing, I'm playing guitar, I'm doing something else to create distance between
(11:39):
this thing that was bugging me. Then I can come back in a logical place and revisit.
Part two would be communicate with a trusted person. And the other thing is it's therapy comes
in all shapes and sizes, so it doesn't always have to be a formal sit down with a therapist. I mean,
there's been plenty of, by definition, therapeutic moments between myself and like baseball coaches
(12:01):
that will kind of say something in passing that sticks with me 30 years later. I was
10 years old. He said something. I was worried. I was having an emotional reaction to making an
error. I was worried. He said, “well, if you make an error or mistake,
make it at 100 miles an hour. You can't control the error, but you can control your hustle.”
(12:22):
So that shifted my perspective. 30 years later, I still think,
and it wasn't like a scheduled appointment to have that. So I think having the eyes to know
what's usable through life for sure is a good coping mechanism. You can like search for things,
because if you're looking for ways or reasons that my life is bad,
(12:44):
you'll find them. So a good coping mechanism is to target out on that perspective. Well,
what are you looking for all day? Reasons why your life is bad or reasons why you're blessed?
Yeah. Yeah. You're going to see what you are focusing on.
Totally. Totally.
When my boys were teens and something I do for myself is what I call “soul putty.” And that is,
(13:12):
for me, it’s music. I play the guitar, but it's putty that's going to fill
the cracks in your soul. How do you make yourself feel better by yourself? It could
be run. It could be a walk. It's reading. Whatever. The thing doesn't matter. Right?
I love that. I love soul putty.
(13:34):
Yeah. We could all use some soul putty, right? I love that. I love that.
On a fundamental level, if something seemingly dangerous happens, and by danger I don't mean
an actual predator chasing us. But if we brand something, if we have a core belief,
we need to be liked all day, every day by everyone, something like that, and then
reality sets in and then we're not. If somebody gives us a dirty look or something and kind of
(13:58):
clashes with that core belief, it really will send a signal to your nervous system, we're in trouble.
So that instant instinctual primal response, it really does put you in kind of a whirl,
anger, fear, whatever. And it does take a few minutes to kind of get out of it before you
have a real metric of how severe this actually was. And then when you're in that logical place,
(14:22):
you can play it out and be like, well, on a scale of one to 10, it's like a 1,
because if they had a bad thought about me, A, I don't even know about it,
and B, my life changes in 0 ways. But then you start thinking in that way.
So I think coping mechanisms kind of come down to finding
a way to chill out until you can think clearly.
That's great advice.
Yeah. I think once they're in that place where they can think clearly. And that is the good part
(14:45):
about therapy, because that is a place of logic. So they're typically not angry in that meeting,
but they say, well, I did A, B, and C this week. And then when we talk about it,
they get to see all the discrepancies. It's like tracing paper. They're like,
well, I did A, B, and C. That was stupid. I can see that now.
What to Do When You Need Professional Help for Your Son
Right. So as a parent, let's say that you've come to the conclusion that you're in over your
(15:12):
head and you want to find somebody to help you navigate the stress that is going on.
So where do you start? Do you start with the school counselor, the pediatrician, and how
do you find the right counselor for your child?Right. I think obviously your son spends most of
(15:33):
his time at school. So any information from school or teachers, I mean, they spend all kinds of time
with your son. So they'll pick up on things. So it's always a good idea to start with school.
The school counselor is good for kind of an after conversation of like, we see this,
this, and this. What do you think? I think teachers are the people to talk
to because they actually watch your son in the middle of battle. They're like,
(15:55):
it's longer than nine seconds or whatever it may be, it gets kind of tantrums or whatever.
Secondly, if there's something going on, I think to go to the medical route for sure,
bio-psycho-social is a good framework. So the bio would be, could be anything. I mean,
I've seen people come to me that were just so depressed, a 13 year old boy is what I'm
(16:18):
thinking about. So depressed. And then he got his blood work and it was like low B12. He took B12
supplements over the counter. It wasn't depressed anymore because he was sluggish, whatever.
So it's like, start, just start with the basics. I'm not saying it's always going
to fix whatever it is, but like it's, it would just be a shame if it's like
six months of therapy and the poor guy still feels sluggish. So start with those
(16:42):
kinds of numbers like blood work, thyroid effects, mood, all kinds of stuff like that.
So school, medical, and then therapy. I wouldn't necessarily, if you can bear
doing therapy without medicine, I would always save psychotropic medicine for last if you can.
(17:03):
Just give therapy a shot. See if there's, you know, natural things like communication,
talk therapy first, I would say.Right. You know, because the boys
were always sensitive to anybody that I was bringing in to give them assistance,
I ended up calling everybody “coach.” So tutors were coach, it was the math coach,
(17:29):
and the health professionals were life coaches. We talked about, do you need a little mental floss,
you know, to just, you know, make it a little bit more accepting for them.
So how would you suggest a mom prepare their son for their first visit and what should
(17:50):
they expect? Are they going to be part of it? You know, you want both parents or,
you know, no matter what the, you know, the family looks like dynamically?
Sure. I think establishing a baseline of your son's personality going in. So
if he's more introverted, you obviously don't want like the entire family and
then extended family and grandma like coming to the first session.
(18:11):
If they have the kind of personality where they would love the support and they have things,
you know, they're just kind of this outgoing person. So I think
the baseline of the personality is always a good thing to know. Like on an average day,
what is my son like? That's also good for noticing if something takes a turn in the
mental realm too. So this is out of character for him. That's kind of another warning sign.
(18:36):
Preparing him for the first session is really, this is all your thing. If I have issues, this
is mom talking, “if I have issues of my own, I'll see my own therapist, but this is your time. You
talk about whatever is matters to you.” Completely private. Say anything. There's going to be two
(18:56):
sides. We might be going beyond what a mom would say, but there's going to be two sides to it,
which is supportive and educational, which means the supportive side you can vent. You can say
anything you want, anything that bugs you, get it out. It's all valid. It's all good. Somebody is
there to hear you and validate you and it, and it matters. It's important what you're going through.
The educational side, if you have an issue that you'd like feedback from, that's there too.
(19:24):
So therapy or coaching is about supportive and educational kind of going hand in hand there.
So it's not just going to be, Oh, that's easy. Just do this. Like if somebody comes in,
I'm super anxious and depressed. Oh, that's easy. Just do this. It doesn't go well. That doesn't go
well. And that's the reason why I kind of say, save this psychotropic medication for as late
as possible, if possible, because I want to get to know everything about this lifestyle first.
(19:48):
You know, well, he's staying up till 4 a.m. and mom didn't know. So of course he's being a jerk.
Right? And how long does that typically take? Like the, you know, how, how long do you typically see
some, somebody? I found that we went back and forth. Like we'd go for a little while. We get,
we get all the floss cleaned out and then, you know, then we had a break.
(20:13):
Yeah, yeah, yeah. So that kind of goes with the ebb and flow thing. So I can relate to
that. I'm not a mother, of course, but I can relate to that in the way of,
it really is an ebb and flow. So my door is always open and there's no expectations on my
end to come talk or not. You know, if you're, if you're doing okay, then I'm okay kind of thing.
(20:34):
Different for moms because you can't kind of be that chill and just be like, if whatever,
if you're fine, I'm fine, you know, because there are things to do, you know,
there needs to be some functionality, of course, but I think if it was the,
the boy or the teenager, the young adults decision to come, then it's really important that if he's,
(20:59):
if he's done for that time, then he's done for that time, for that round.
And I never say, well, you know, we really got more stuff to work on. I
really rarely say that because it's, I just want them to know the door's open,
come back anytime. It's just a very, we don't get that a lot of times in life where it's just like,
you get to call the shots and like be totally honest and no consequences.
(21:23):
Yeah. You need to respect their,
how they're feeling and what they're up for and what they have energy for.
Totally, totally.
So in your experience, what has been the toughest age for young males?
I would say just the word, the word is coming up for me right now is transitions. So I would see,
(21:45):
you know, you first start to reason abstractly at like 12 reason abstractly meaning like it's,
we just went from two dimensional thinking to like something bad happened, therefore it must
be my fault. It's very cause and effect. It's very black and white. It's like something bad,
my fault, I'm bad. 12 on you get this like reason about it where it's like something bad happened.
It was unrelated to me. It's just something that was unfair. I didn't do anything. There's
(22:09):
not connected. Actually, Inside Out has a good scene. The cartoons are like dancing around and
they go into a tunnel and they're 2D and she was like, this is like the two dimensional thinking
and then they become 3D. So it's like, and cause I think her name is Riley, the main character.
She was like right at that age where she's able to think in that way of like, we're reasoning in ways
(22:32):
now. So I think going into kindergarten is scary for some reasons, but not like the reasons… It's
like scary. It's like, I'm going to be away from parents for a little while. It's like still 2D.
Then 3D happens like 12, like around middle school. So now it's like,
I'm like the world just opened in my brain. Like I see a bigger world and now
(22:54):
I'm transitioning into a bigger school, harder work, more people around, more social stuff.
So I would say 11 is tough going into middle school. You're obviously your body's changed,
you're prepubescent. So then we have to talk about girls, things like that. It's
always tough. Like, you know, your voice cracks and you have a pimple, whatever.
(23:17):
And then I would say part two is probably senior year of high school,
just another transition. You know, your friends going to Harvard and you're going
to community college. You're like, what does this mean for my ego? My sense of self, right?
Anything ego driven from like 11 to 18, meaning driving, girls, the amount of friends, popular,
(23:38):
am I doing sports? The comparison aspect I think causes a lot of stress for young guys.
That's what you're seeing. You're seeing a lot of
that where they're coming in stressed about those things.
All the time. And it's interesting because I started just long enough to get a picture of
pre-social media life. So I would see a 16 year old in like 2010, 2011, and it was a
(24:06):
very different conversation than right now. Now it's like, well, I see everybody just, you know,
is like going on a cruise to the Bahamas with like supermodels and Ferraris. And I'm not.
Yeah. Right. Well, that comparative thinking is always, you know, a struggle. I think it's
(24:28):
a struggle for adults, too. So it's part of, you know, my inspiration for writing
the book was to just be a little bit more honest about it all. And with this podcast.
One of the things that I tried to encourage the boys to do, which was not easy, was to
(24:53):
volunteer and to help, you know, do something for somebody else because I feel as though it helped
build confidence and it became a win-win. And, you know, are there, do you find that dynamics
helpful in your practice? Are there ways for boys to, I don't know,
(25:14):
talk with each other? I can't imagine a bunch of boys sitting in a room talking with each
other like that. But in the perfect world, are there those sort of situations available?
Absolutely. I mean, I love the volunteer idea. I think it really comes down to if
it checks off some boxes. And one of these is kind of goes back to the coping mechanism.
(25:37):
But if it's if I can break myself down into three parts, I'm a thinker, feeler,
doer. Each have, you know, their their gifts, their perks and their their curses.
So I think doing in a time of anything challenging is always a good idea. Going
and doing something because these guys get in their heads and think a lot about every
(25:58):
possible scenario in a way to defend or prepare for future stuff. But going and
doing getting feedback from reality in real time is just the best medicine in the world.
And I mean, if you can do something to help others,
if you can, like. Really facilitate that kind of like altruistic approach, that's incredible.
(26:19):
Special Olympics was always one of those great opportunities because
they needed huggers. They and they're willing to take
teenagers to support other teenagers.Link to Volunteer for Special Olympics
And that's that's incredible. That's the perfect. I love that outlet. I really do. I mean, I,
you know, I've seen people kind of like take up tennis or do something like that. But it's like,
(26:40):
this is so much better. There's a community and there's purpose. There's purpose.
It's like you're helping and, you know, you're helping yourself in the process.
So, Adam, since COVID, it seems to me like tele appointments are are much more prevalent.
(27:04):
Do you think they are still effective for teenagers and teenage males?
I really, really do. I really do. And I'm reminded of a story,
a quick one where I was on a phone call, which is very rare for me. I at least do
video. We kind of like traditionally we kind of like to see facial expressions and things
(27:26):
like that. But whatever for whatever reason, we were just on the phone.
And I was opening up a drink like Coke or something. And I pushed mute so this guy
didn't have to hear the obnoxious thing of an opening. And I didn't take it off mute.
I just forgot that I'm listening and I'm kind of saying, uh huh. And I asked the question,
(27:46):
there was a kind of a pause and I asked a question I was interested in. I was like,
what what happened there or something like that? Just leading. But he didn't hear me,
obviously. So there was to him, there was a silence.
That continued probably like three or four times when I'm looking back, just thinking about like,
he can't hear me at all. He ends up going into this emotional place and getting very emotional,
(28:09):
like very upset and start crying. He just needed silence to kind of work some things
out. And so and mind you, we had we had met in person every time up to then he never
got to that place ever. So for a guy like that, it was better that I wasn't sitting
there staring at him because he was more comfortable just talking and kind of like
(28:31):
just knowing I'm there, but not staring at him. It wasn't invasive, you know?
So he cried and he had this nice moment of like, yeah, I just needed to get that out. You know, it
was like a really nice thing. And I was on mute. I was talking to him. So I unmute. I was like, OK,
OK. I wasn't being this genius therapist because I wasn't letting it breathe like I should have.
(28:53):
I think as moms, too, we tend to want- our child comes to us. They're hopefully
coming to us because we help them feel vulnerable and safe. And they come to
us and they express something that's going on. And I think that we tend to jump in and
want to rescue and give advice all of a sudden and just like try to solve it for them. So I
(29:17):
think that that whole thing with even giving our kids silence like that, just we just to
be there and let them just sit with us without speaking is probably a good strategy sometimes.
Right. Based on what the story you just told. Yeah, I would say 90 % of the time
it's that. They're looking for supportive, not educational. So supportive, meaning just I mean,
(29:43):
the most powerful two words. Some of some of these young guys have told me
that their parents have said to me, is “that sucks.” Parents are just like, that sucks.
Yeah. Just understanding without coming in and trying to give advice.
But there's something almost there's something almost dismissive about,
“well, that's easy. Just do A, B and C.” And I mean, if you look at it from like a team,
(30:05):
we’re a team. So if you need some help with this, this and this, let me know.
But you got it. You're the boss. This is your thing. You got it. I'm here if you need me.
Well, and that's part of that transition to independence, that you need to work through
as a parent and as a child and in that high school period, because we we want them to become
(30:28):
independent and launch and make decisions. And if we're making decisions for them nonstop and
they don't do it for themself, and they don't fail, then they miss that opportunity. Totally.
Yeah. I mean, that's such a good point. I mean, if the parents are doing everything for them,
you're not exposing them to a real situation where they have to survive.
(30:50):
Right.
So, Adam, every week, we ask our guests if they can share with us a motto that
pertains to the topic of the day. So do you have something, a motto that you
would recommend for a mom trying to support her son through the trials of growing up?
(31:12):
It's a really good question. Let's say a good motto would be whose needs are being
met by what's being done. If your son is driving you up a wall and you yell at him,
was it for his best interest that he got yelled at in that moment, or are you mad
and you wanted to yell for your own needs? That would be the motto for parenting, I would say.
(31:38):
Can you say that one more time?
Whose needs are being met by what's being done? Yeah, that's great.
Well, Adam, thank you so much for joining us for
this conversation. We hope you will come back in the future.
Of course, my pleasure. There's lots of other topics related, you know,
because sometimes the wheels just come totally off the bus.
(32:03):
Perfectly said.
For our listening audience, if you would like to contact Adam,
please visit cmhahelps.com is his website, and we'll have
this podcast and other resources available on the website mothersofboys.life.
(32:25):
And thank you all for joining us today. Follow the mob on Facebook, Instagram,
YouTube and your favorite podcast platform. Be kind to yourselves, moms, and have a great week.
Raising Emotionally Resilient Boys and Young Men.
Welcome back to the Mothers of Boys Survival Guide, the podcast where we
talk about raising boys and everything that comes with it. I'm Cheryl Bohn,
and with me today is co-host and author Suzy Shaw.
Hello Cheryl, and glad you all are joining us, Mothers of Boys.
(00:24):
Well today's episode tackles some things that moms quietly worry about - our sons
mental health? Are they just moody? Or is something deeper going on? Why do they shut
us out when we try to help? How do we teach them to express their feelings? What is the appropriate
level of freedom to give? And how do we know when it's time to get professional support?
(00:46):
The truth is, teen boys are struggling more than we think. Anxiety, depression, anger,
and difficulty expressing their feelings. How is masculinity even defined for boys today?
This is a conversation every mother of boys needs to hear. As a mom,
you're pretty good at triage and identifying the right bandage for the current scrape or injury,
(01:11):
but the signs of mental health issues are sometimes much harder to identify.
Well in this episode, we're talking to a licensed mental health counselor who
specializes in advising and guiding parents and young people as they develop and mature. Our guest
today is Adam Iacarino, a licensed clinical psychologist with expertise in depression,
(01:35):
anxiety, spectrum disorders, and ADHD. Adam founded Community Mental Health Associates
in 2010 and Elevation Therapy Group in 2021. He provides regular consultation to families,
psychiatric hospitals, and public and private schools. Welcome Adam.
(01:55):
Hello. Thank you so much for having me.
We really appreciate you joining us and I know I have a great deal of respect
and appreciation for mental health professionals and there were several
periods during our boys' lives growing up that we found professionals just incredibly
(02:18):
helpful in guiding us and guiding the boys. Can we start from the beginning,
Adam? Can you describe some of the warning signs and when we should go find somebody like you?
Absolutely. Well, first of all, I thank you both for doing this podcast because,
so 2010, so November will be 15 years and I can just see every mother that I've worked with,
(02:46):
they make the same face when they bring their son in, whatever age, and they all
make a similar face which was like, what the hell was that? What do I do? What is happening?
So this is such a needed thing you guys are doing. So warning signs for sure.
So I want to avoid any kind of general sweeping statements and one size fits
(03:08):
all. So I like frameworks. So a warning sign would be anything maladaptive that
has an impact on the framework of his life. So we'll say, we use a framework
called PEPSI (Person - Emotional - Physical - Social- Intellectual). So a very, very smart
psychologist once, he mentored me, he was just like a father to me, he taught me about Pepsi.
(03:28):
And PEPSI's not the drink?
Pepsi's not the drink, not this time. PEPSI equals the four sides of the young man,
emotional, physical, social, intellectual. So if there are thoughts or behaviors or
even motivations that are impacting one of those four sides of himself negatively,
(03:53):
then it's time for concern and maybe reach out to a mental health professional.
So it could be thoughts. He has plans to go out Saturday night with friends,
but he can't, he doesn't, he says he doesn't want to,
but he can't really do it because there are certain ways of thinking
that are impacting the way he views himself or how he assimilates things into his life.
(04:19):
Can you say those again?
So PEPSI is the person, the overall person is emotional, physical, social, and intellectual.
So we can fit school, we can fit friends, we can fit extracurriculars, anything active, sports,
things like that. So if anything's being impacted where, “man, this is the third week in a row,
(04:41):
he's mispracticed, what's going on with this guy?” We got to dig a little deeper. Rather
than he's just being a little weird, being a little quirky, had a few nights where he
couldn't really sleep, things like that. Not mental health concerns right off the
bat. If it's not impacting things, well yeah, I was tired, but I still did what I had to do.
So the old DSM (Diagnostic and Statistical Manual of Mental Disorders), the fifth axis was
(05:01):
global impact of functioning. How functional, how is this disorder,
if it is a disorder, how is this disorder impacting his everyday life?
So I mean, something could be mild that we still would want to look into. So on a way of,
we want to limit the suffering, limit any kind of emotional distress. That's
a thing. If he says like, “I'm sad, I'm still doing what I got to do,
(05:24):
but I'm sad about something.” Then, of course, then we want to reach out to a
counselor as well. But in terms of, you don't know anything other than what you're seeing.
But how can you, how do you differentiate? I think there's definitely mood swings when
they become teenagers or there's different things. How can you differentiate between
typical teenage behavior and something that would be a mental health concern?
(05:48):
Well, if there's mood swings and he's still attending school, still eating,
still doing these four parts of himself, they're still intact. So we can still function through the
mood swings and we can do things in a bad, the bad moods aren't so severe that we're not functioning.
Okay.
I mean, we can, we can pretty much bank on mood swings, boys are going to be just as moody as
(06:15):
anything, you know? So it's whether we show it or not is going to be the deciding factor. That's why
I like this podcast so much, because it's like, what a warning signs that we have in our head,
these tools that we have in our back pocket so we know what to look for. You
know what I mean? Because they're not always going to come out and be like,
I had an emotionally trying math test today.One of the things for me that was really important
(06:42):
was trying to build trust and building trust with a teenager is, was difficult,
it definitely ebbed and flowed in one minute, you're their best friend and the next minute
they hate you and the door's getting slammed. And I mean, the, you know, my two boys in the book,
(07:04):
I call them Earnest and Exuberance and I had one that when he was really upset, he would spin down
inside himself and get super quiet. And then the other one would spin outward and there was no,
you know, there was no question as to whether he was upset or not, because he was just loud.
(07:29):
So you know, what can a parent do to ensure that their child,
you know, knows and can trust and can express their feelings.
What I've learned is it's less of they hate you and more of they don't have the vocabulary.
(07:50):
So slamming a door is kind of by default, just more instinctual and it just feels right. I have
a surge of whatever adrenaline, I'm very angry. So slamming the door seems like the right thing
to do. And it's, I mean, it's unrefined, of course, but that's kind of the thing.
So actions don't always equal what's going on inside, which is always a good thing. So if
(08:11):
you hear the door slam, you're like, man, that's really something going on that's very severe. When
a lot of times it's just a moment. And sometimes it's like 10 minutes later, he's back to normal.
So once that like, that outer brain, the logic kind of kicks back in and they're like, dude,
it wasn't that big of a deal, you know, but in the moment they'll scream and kind of, because
they don't, a lot of them don't have the vocabulary. So a lot of times in therapy,
(08:33):
it's a lot of like feelings, words and communication techniques of like stopping,
forming a sentence, which actually buys them some time, things like that.
If you need to do 20 pushups, that's cool, to get like adrenaline out or something.
How do we get them to feel comfortable speaking to us when something's bothering them? You know,
a lot of times kids are afraid they're going to get in trouble or they're afraid maybe like
(08:58):
we want to build that trust and then get them to feel comfortable. Do you have any advice for that?
Of course. I think the worst thing to do would be practice a fire drill in the fire. So if the only
time you two ever speak is when you're expecting him to share hard feelings, that's a mistake. We
have to set a rapport. There needs to be some kind of rapport relationship beforehand that
(09:23):
we've talked about 10 funny things so the door is open to talk about this one serious thing.
So sometimes I'll talk to parents and they're like, well,
he just never talks to us about anything. I'm like, when was the last time you guys
did anything fun together? So it's like, well, if I never talked to somebody and
then I had a tough day, I wouldn't go to them. So you need to have that rapport.
(09:45):
And, you know, I kind of faced this in therapy on the first few sessions because I've never met this
person. It's very clear. Like it's clear that they don't want to just come in bursting with personal
information about vulnerabilities and things like that. So I first need to build that rapport. And
I'll even, you know, self disclose some things if that helps back and forth. So sometimes moms
(10:06):
can share, you know, I've had a tough day the other day, too. And you can tell them about it.
You know, so and also, I think less, the less formal, the better. It's more like a rolling
conversation. Kind of the door is always open. So the ebb and flow kind of creates this idea that,
well, I need I need some kind of predictable pattern. I need some kind of schedule to
(10:31):
know when things are happening, when in reality, it's really just going to come
up whenever we just have to have the door open. He needs to know it's open whenever.
Can you suggest some coping mechanisms when when the boys are going through a stressful time?
Sure. I think a lot of teenage are we are we're focused on more
(10:53):
like a teenage kind of sit or just all like zero to 18 or.
Well, what age do you typically find boys start to come to see you?
Early high school. So 14 to like early 20s.
Well, so coping for a five year old is going to look different
than an 18 year old. So coping for a five year old is like, you know,
color some stuff and give it nine minutes and we're a different person. Right.
(11:18):
A 15 year old. There tends to be overthinking. So things to giving that monkey brain something else
to play with is typically the coping mechanism that works the best, meaning I'm exercising,
I'm drawing, I'm playing guitar, I'm doing something else to create distance between
(11:39):
this thing that was bugging me. Then I can come back in a logical place and revisit.
Part two would be communicate with a trusted person. And the other thing is it's therapy comes
in all shapes and sizes, so it doesn't always have to be a formal sit down with a therapist. I mean,
there's been plenty of, by definition, therapeutic moments between myself and like baseball coaches
(12:01):
that will kind of say something in passing that sticks with me 30 years later. I was
10 years old. He said something. I was worried. I was having an emotional reaction to making an
error. I was worried. He said, “well, if you make an error or mistake,
make it at 100 miles an hour. You can't control the error, but you can control your hustle.”
(12:22):
So that shifted my perspective. 30 years later, I still think,
and it wasn't like a scheduled appointment to have that. So I think having the eyes to know
what's usable through life for sure is a good coping mechanism. You can like search for things,
because if you're looking for ways or reasons that my life is bad,
(12:44):
you'll find them. So a good coping mechanism is to target out on that perspective. Well,
what are you looking for all day? Reasons why your life is bad or reasons why you're blessed?
Yeah. Yeah. You're going to see what you are focusing on.
Totally. Totally.
When my boys were teens and something I do for myself is what I call “soul putty.” And that is,
(13:12):
for me, it’s music. I play the guitar, but it's putty that's going to fill
the cracks in your soul. How do you make yourself feel better by yourself? It could
be run. It could be a walk. It's reading. Whatever. The thing doesn't matter. Right?
I love that. I love soul putty.
(13:34):
Yeah. We could all use some soul putty, right? I love that. I love that.
On a fundamental level, if something seemingly dangerous happens, and by danger I don't mean
an actual predator chasing us. But if we brand something, if we have a core belief,
we need to be liked all day, every day by everyone, something like that, and then
reality sets in and then we're not. If somebody gives us a dirty look or something and kind of
(13:58):
clashes with that core belief, it really will send a signal to your nervous system, we're in trouble.
So that instant instinctual primal response, it really does put you in kind of a whirl,
anger, fear, whatever. And it does take a few minutes to kind of get out of it before you
have a real metric of how severe this actually was. And then when you're in that logical place,
(14:22):
you can play it out and be like, well, on a scale of one to 10, it's like a 1,
because if they had a bad thought about me, A, I don't even know about it,
and B, my life changes in 0 ways. But then you start thinking in that way.
So I think coping mechanisms kind of come down to finding
a way to chill out until you can think clearly.
That's great advice.
Yeah. I think once they're in that place where they can think clearly. And that is the good part
(14:45):
about therapy, because that is a place of logic. So they're typically not angry in that meeting,
but they say, well, I did A, B, and C this week. And then when we talk about it,
they get to see all the discrepancies. It's like tracing paper. They're like,
well, I did A, B, and C. That was stupid. I can see that now.
What to Do When You Need Professional Help for Your Son
Right. So as a parent, let's say that you've come to the conclusion that you're in over your
(15:12):
head and you want to find somebody to help you navigate the stress that is going on.
So where do you start? Do you start with the school counselor, the pediatrician, and how
do you find the right counselor for your child?Right. I think obviously your son spends most of
(15:33):
his time at school. So any information from school or teachers, I mean, they spend all kinds of time
with your son. So they'll pick up on things. So it's always a good idea to start with school.
The school counselor is good for kind of an after conversation of like, we see this,
this, and this. What do you think? I think teachers are the people to talk
to because they actually watch your son in the middle of battle. They're like,
(15:55):
it's longer than nine seconds or whatever it may be, it gets kind of tantrums or whatever.
Secondly, if there's something going on, I think to go to the medical route for sure,
bio-psycho-social is a good framework. So the bio would be, could be anything. I mean,
I've seen people come to me that were just so depressed, a 13 year old boy is what I'm
(16:18):
thinking about. So depressed. And then he got his blood work and it was like low B12. He took B12
supplements over the counter. It wasn't depressed anymore because he was sluggish, whatever.
So it's like, start, just start with the basics. I'm not saying it's always going
to fix whatever it is, but like it's, it would just be a shame if it's like
six months of therapy and the poor guy still feels sluggish. So start with those
(16:42):
kinds of numbers like blood work, thyroid effects, mood, all kinds of stuff like that.
So school, medical, and then therapy. I wouldn't necessarily, if you can bear
doing therapy without medicine, I would always save psychotropic medicine for last if you can.
(17:03):
Just give therapy a shot. See if there's, you know, natural things like communication,
talk therapy first, I would say.Right. You know, because the boys
were always sensitive to anybody that I was bringing in to give them assistance,
I ended up calling everybody “coach.” So tutors were coach, it was the math coach,
(17:29):
and the health professionals were life coaches. We talked about, do you need a little mental floss,
you know, to just, you know, make it a little bit more accepting for them.
So how would you suggest a mom prepare their son for their first visit and what should
(17:50):
they expect? Are they going to be part of it? You know, you want both parents or,
you know, no matter what the, you know, the family looks like dynamically?
Sure. I think establishing a baseline of your son's personality going in. So
if he's more introverted, you obviously don't want like the entire family and
then extended family and grandma like coming to the first session.
(18:11):
If they have the kind of personality where they would love the support and they have things,
you know, they're just kind of this outgoing person. So I think
the baseline of the personality is always a good thing to know. Like on an average day,
what is my son like? That's also good for noticing if something takes a turn in the
mental realm too. So this is out of character for him. That's kind of another warning sign.
(18:36):
Preparing him for the first session is really, this is all your thing. If I have issues, this
is mom talking, “if I have issues of my own, I'll see my own therapist, but this is your time. You
talk about whatever is matters to you.” Completely private. Say anything. There's going to be two
(18:56):
sides. We might be going beyond what a mom would say, but there's going to be two sides to it,
which is supportive and educational, which means the supportive side you can vent. You can say
anything you want, anything that bugs you, get it out. It's all valid. It's all good. Somebody is
there to hear you and validate you and it, and it matters. It's important what you're going through.
The educational side, if you have an issue that you'd like feedback from, that's there too.
(19:24):
So therapy or coaching is about supportive and educational kind of going hand in hand there.
So it's not just going to be, Oh, that's easy. Just do this. Like if somebody comes in,
I'm super anxious and depressed. Oh, that's easy. Just do this. It doesn't go well. That doesn't go
well. And that's the reason why I kind of say, save this psychotropic medication for as late
as possible, if possible, because I want to get to know everything about this lifestyle first.
(19:48):
You know, well, he's staying up till 4 a.m. and mom didn't know. So of course he's being a jerk.
Right? And how long does that typically take? Like the, you know, how, how long do you typically see
some, somebody? I found that we went back and forth. Like we'd go for a little while. We get,
we get all the floss cleaned out and then, you know, then we had a break.
(20:13):
Yeah, yeah, yeah. So that kind of goes with the ebb and flow thing. So I can relate to
that. I'm not a mother, of course, but I can relate to that in the way of,
it really is an ebb and flow. So my door is always open and there's no expectations on my
end to come talk or not. You know, if you're, if you're doing okay, then I'm okay kind of thing.
(20:34):
Different for moms because you can't kind of be that chill and just be like, if whatever,
if you're fine, I'm fine, you know, because there are things to do, you know,
there needs to be some functionality, of course, but I think if it was the,
the boy or the teenager, the young adults decision to come, then it's really important that if he's,
(20:59):
if he's done for that time, then he's done for that time, for that round.
And I never say, well, you know, we really got more stuff to work on. I
really rarely say that because it's, I just want them to know the door's open,
come back anytime. It's just a very, we don't get that a lot of times in life where it's just like,
you get to call the shots and like be totally honest and no consequences.
(21:23):
Yeah. You need to respect their,
how they're feeling and what they're up for and what they have energy for.
Totally, totally.
So in your experience, what has been the toughest age for young males?
I would say just the word, the word is coming up for me right now is transitions. So I would see,
(21:45):
you know, you first start to reason abstractly at like 12 reason abstractly meaning like it's,
we just went from two dimensional thinking to like something bad happened, therefore it must
be my fault. It's very cause and effect. It's very black and white. It's like something bad,
my fault, I'm bad. 12 on you get this like reason about it where it's like something bad happened.
It was unrelated to me. It's just something that was unfair. I didn't do anything. There's
(22:09):
not connected. Actually, Inside Out has a good scene. The cartoons are like dancing around and
they go into a tunnel and they're 2D and she was like, this is like the two dimensional thinking
and then they become 3D. So it's like, and cause I think her name is Riley, the main character.
She was like right at that age where she's able to think in that way of like, we're reasoning in ways
(22:32):
now. So I think going into kindergarten is scary for some reasons, but not like the reasons… It's
like scary. It's like, I'm going to be away from parents for a little while. It's like still 2D.
Then 3D happens like 12, like around middle school. So now it's like,
I'm like the world just opened in my brain. Like I see a bigger world and now
(22:54):
I'm transitioning into a bigger school, harder work, more people around, more social stuff.
So I would say 11 is tough going into middle school. You're obviously your body's changed,
you're prepubescent. So then we have to talk about girls, things like that. It's
always tough. Like, you know, your voice cracks and you have a pimple, whatever.
(23:17):
And then I would say part two is probably senior year of high school,
just another transition. You know, your friends going to Harvard and you're going
to community college. You're like, what does this mean for my ego? My sense of self, right?
Anything ego driven from like 11 to 18, meaning driving, girls, the amount of friends, popular,
(23:38):
am I doing sports? The comparison aspect I think causes a lot of stress for young guys.
That's what you're seeing. You're seeing a lot of
that where they're coming in stressed about those things.
All the time. And it's interesting because I started just long enough to get a picture of
pre-social media life. So I would see a 16 year old in like 2010, 2011, and it was a
(24:06):
very different conversation than right now. Now it's like, well, I see everybody just, you know,
is like going on a cruise to the Bahamas with like supermodels and Ferraris. And I'm not.
Yeah. Right. Well, that comparative thinking is always, you know, a struggle. I think it's
(24:28):
a struggle for adults, too. So it's part of, you know, my inspiration for writing
the book was to just be a little bit more honest about it all. And with this podcast.
One of the things that I tried to encourage the boys to do, which was not easy, was to
(24:53):
volunteer and to help, you know, do something for somebody else because I feel as though it helped
build confidence and it became a win-win. And, you know, are there, do you find that dynamics
helpful in your practice? Are there ways for boys to, I don't know,
(25:14):
talk with each other? I can't imagine a bunch of boys sitting in a room talking with each
other like that. But in the perfect world, are there those sort of situations available?
Absolutely. I mean, I love the volunteer idea. I think it really comes down to if
it checks off some boxes. And one of these is kind of goes back to the coping mechanism.
(25:37):
But if it's if I can break myself down into three parts, I'm a thinker, feeler,
doer. Each have, you know, their their gifts, their perks and their their curses.
So I think doing in a time of anything challenging is always a good idea. Going
and doing something because these guys get in their heads and think a lot about every
(25:58):
possible scenario in a way to defend or prepare for future stuff. But going and
doing getting feedback from reality in real time is just the best medicine in the world.
And I mean, if you can do something to help others,
if you can, like. Really facilitate that kind of like altruistic approach, that's incredible.
(26:19):
Special Olympics was always one of those great opportunities because
they needed huggers. They and they're willing to take
teenagers to support other teenagers.Link to Volunteer for Special Olympics
And that's that's incredible. That's the perfect. I love that outlet. I really do. I mean, I,
you know, I've seen people kind of like take up tennis or do something like that. But it's like,
(26:40):
this is so much better. There's a community and there's purpose. There's purpose.
It's like you're helping and, you know, you're helping yourself in the process.
So, Adam, since COVID, it seems to me like tele appointments are are much more prevalent.
(27:04):
Do you think they are still effective for teenagers and teenage males?
I really, really do. I really do. And I'm reminded of a story,
a quick one where I was on a phone call, which is very rare for me. I at least do
video. We kind of like traditionally we kind of like to see facial expressions and things
(27:26):
like that. But whatever for whatever reason, we were just on the phone.
And I was opening up a drink like Coke or something. And I pushed mute so this guy
didn't have to hear the obnoxious thing of an opening. And I didn't take it off mute.
I just forgot that I'm listening and I'm kind of saying, uh huh. And I asked the question,
(27:46):
there was a kind of a pause and I asked a question I was interested in. I was like,
what what happened there or something like that? Just leading. But he didn't hear me,
obviously. So there was to him, there was a silence.
That continued probably like three or four times when I'm looking back, just thinking about like,
he can't hear me at all. He ends up going into this emotional place and getting very emotional,
(28:09):
like very upset and start crying. He just needed silence to kind of work some things
out. And so and mind you, we had we had met in person every time up to then he never
got to that place ever. So for a guy like that, it was better that I wasn't sitting
there staring at him because he was more comfortable just talking and kind of like
(28:31):
just knowing I'm there, but not staring at him. It wasn't invasive, you know?
So he cried and he had this nice moment of like, yeah, I just needed to get that out. You know, it
was like a really nice thing. And I was on mute. I was talking to him. So I unmute. I was like, OK,
OK. I wasn't being this genius therapist because I wasn't letting it breathe like I should have.
(28:53):
I think as moms, too, we tend to want- our child comes to us. They're hopefully
coming to us because we help them feel vulnerable and safe. And they come to
us and they express something that's going on. And I think that we tend to jump in and
want to rescue and give advice all of a sudden and just like try to solve it for them. So I
(29:17):
think that that whole thing with even giving our kids silence like that, just we just to
be there and let them just sit with us without speaking is probably a good strategy sometimes.
Right. Based on what the story you just told. Yeah, I would say 90 % of the time
it's that. They're looking for supportive, not educational. So supportive, meaning just I mean,
(29:43):
the most powerful two words. Some of some of these young guys have told me
that their parents have said to me, is “that sucks.” Parents are just like, that sucks.
Yeah. Just understanding without coming in and trying to give advice.
But there's something almost there's something almost dismissive about,
“well, that's easy. Just do A, B and C.” And I mean, if you look at it from like a team,
(30:05):
we’re a team. So if you need some help with this, this and this, let me know.
But you got it. You're the boss. This is your thing. You got it. I'm here if you need me.
Well, and that's part of that transition to independence, that you need to work through
as a parent and as a child and in that high school period, because we we want them to become
(30:28):
independent and launch and make decisions. And if we're making decisions for them nonstop and
they don't do it for themself, and they don't fail, then they miss that opportunity. Totally.
Yeah. I mean, that's such a good point. I mean, if the parents are doing everything for them,
you're not exposing them to a real situation where they have to survive.
(30:50):
Right.
So, Adam, every week, we ask our guests if they can share with us a motto that
pertains to the topic of the day. So do you have something, a motto that you
would recommend for a mom trying to support her son through the trials of growing up?
(31:12):
It's a really good question. Let's say a good motto would be whose needs are being
met by what's being done. If your son is driving you up a wall and you yell at him,
was it for his best interest that he got yelled at in that moment, or are you mad
and you wanted to yell for your own needs? That would be the motto for parenting, I would say.
(31:38):
Can you say that one more time?
Whose needs are being met by what's being done? Yeah, that's great.
Well, Adam, thank you so much for joining us for
this conversation. We hope you will come back in the future.
Of course, my pleasure. There's lots of other topics related, you know,
because sometimes the wheels just come totally off the bus.
(32:03):
Perfectly said.
For our listening audience, if you would like to contact Adam,
please visit cmhahelps.com is his website, and we'll have
this podcast and other resources available on the website mothersofboys.life.
(32:25):
And thank you all for joining us today. Follow the mob on Facebook, Instagram,
YouTube and your favorite podcast platform. Be kind to yourselves, moms, and have a great week.
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