Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

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Associated Press reporter Tom Odula contributed to this report.

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Gen. 'Stormin' Norman Schwarzkopf Dead at 78

H. Norman Schwarzkopf, the retired general credited with leading U.S.-allied forces to a victory in the first Gulf War, died today at age 78.

The man who Defense Secretary Leon Panetta today called "one of the great military giants of the 20th century" died in Tampa, Fla., where he lived in retirement, the Associated Press reported.

"The men and women of the Department of Defense join me in mourning the loss of General Norman Schwarzkopf, whose 35 years of service in uniform left an indelible imprint on the United States military and on the country," Panetta said in a statement. "My thoughts and prayers are with the Schwarzkopf family in this time of sadness and grief."

Schwarzkopf, called "Stormin' Norman" because of his reportedly explosive temper, led America to two military victories: a small one in Grenada in the 1980s and a big one as de facto commander of allied forces in the Gulf War in 1991.

"'Stormin' Norman' led the coalition forces to victory, ejecting the Iraqi Army from Kuwait and restoring the rightful government," read a statement by former Secretary of State Colin Powell, who was chairman of the Joint Chiefs of Staff during the Gulf War. "His leadership not only inspired his troops, but also inspired the nation."

WATCH: Gen. Norman Schwarzkopf to Saddam Hussein: 'Get Outta Town'

Schwarzkopf's success during that fight, also known as Operation Desert Storm, came under President George H.W. Bush, who through his office today mourned "the loss of a true American patriot and one of the great military leaders of his generation."

Gen. Norman Schwarzkopf to Saddam Hussein: 'Get Outta Town' Watch Video

Gen. Schwarzkopf's '5 Minutes of Unimportant Questions' Watch Video

George H.W. Bush Hospitalized in ICU After 'Setbacks' Watch Video

"Gen. Norm Schwarzkopf, to me, epitomized the 'duty, service, country' creed that has defended our freedom and seen this great nation through our most trying international crises," Bush said. "More than that, he was a good and decent man -- and a dear friend."

Bush's office released the statement though the former president, himself, was ill, hospitalized in Texas with a stubborn fever and on a liquids-only diet.

The current White House occupant, President Obama, also memorialized Schwarzkopf, declaring him "an American original" who "stood tall for the country and Army he loved."

The future four-star general was born Aug. 24, 1934, in Trenton, N.J.

Schwarzkopf's father, who shared his name, directed the investigation of the Lindbergh baby kidnapping as head of the New Jersey State Police, later becoming a brigadier general in the U.S. Army.

Schwarzkopf was raised as an army brat in Iran, Switzerland, Germany and Italy, following in his father's footsteps to West Point, earning an engineering degree and being commissioned as a second lieutenant in 1956.

WATCH: Gen. Schwarzkopf's '5 Minutes of Unimportant Questions'

He earned three Silver Stars for bravery during two tours in Vietnam, gaining a reputation as an opinionated, plain-spoken commander with a sharp temper who would risk his own life for his soldiers.

"He had volunteered to go to Vietnam early just so he could get there before the war ended," said former Army Col. William McKinney, who knew Schwarzkopf from their days at West Point, according to ABC News Radio.

In 1983, as a newly-minted general, Schwarzkopf once again led troops into battle in President Reagan's invasion of Granada, a tiny Caribbean island where the White House saw American influence threatened by a Cuban-backed coup.

But he gained most of his fame in Iraq, where he used his 6-foot-3, 240-pound frame and fearsome temper to drive his forces to victory.

"He was known as a soldier's general," said retired Maj. Gen. Donald Shepperd, as he explained the "Stormin' Norman" nickname to ABC News Radio. "In other words, he really liked the troops and was soft on the troops. But boy, on his general officers, his officers, his NCO's, he was very, very tough and he had a real quick temper."

PHOTOS: In Memoriam: People We Lost in 2012

Gruff and direct, Schwarzkopf said during the Gulf War that his goal was to win the war as quickly as possible and with a focused objective: getting Iraq out of Kuwait.

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Mental illness, poverty haunted Afghan policewoman who killed American

KABUL (Reuters) - The Afghan policewoman suspected of killing a U.S. contractor at police headquarters in Kabul suffered from mental illness and was driven to suicidal despair by poverty, her children told Reuters on Wednesday.

The woman was identified by authorities as Narges Rezaeimomenabad, a 40-year-old grandmother and mother of three who moved here from Iran 10 years ago and married an Afghan man.

On Monday morning, she loaded a pistol in a bathroom at the police compound, hid it in her long scarf and shot an American police trainer, apparently becoming the first Afghan woman to carry out such an attack.

Narges also tried to shoot police officials after killing the American. Luckily for them, her pistol jammed. Her husband is also under investigation.

Her son Sayed, 16, and daughter Fatima, 13, described how they tried to call their parents 100 times after news broke of the shooting, then waited in vain for them to come home.

They recalled Narges's severe mood swings, and how at times she beat them and even pulled out a knife. But the children said she was consistent in bemoaning poverty.

"She was usually complaining about poverty. She was complaining to my father about our conditions. She was saying that my father was poor," Sayid said in an interview in their damp, cold two-room cement house.

On the floor beside him were his mother's prescriptions and a thick plastic bag filled with pills she tried to swallow to end the misery about a month ago. On another occasion, she cut her wrist with a razor, Sayed said.

"My father was usually calm and sometimes would say that she was guilty too because it wasn't a forced marriage. They fell in love and got married."

There was no sign in their neighborhood of the billions of dollars of Western aid that have poured into Afghanistan since the ouster of the Taliban in 2001, or of government investment.

RAW SEWAGE, STAGNANT WATER, DIRT ROADS

The lane outside their home stank of raw sewage.

Dirty, stagnant water filled holes in dirt roads nearby, where children in tattered clothes played and butchers stood by cow's hooves in shops choked by dust.

Afghanistan is one of the world's poorest nations, with a third of its 30 million residents living under the poverty line.

The sole distractions from the daily grind appeared to be a deck of playing cards and a compact disc with songs from Iranian pop singers, scattered on the floor of a room where Narges would lock herself in and weep, or sit in silence.

At times, Narges would try to focus on building her children's confidence, telling them to be guided by the Muslim holy book, the Koran, to tackle life's problems.

Sayed and Fatima said she never spoke badly of the U.S. presence in Afghanistan or of President Hamid Karzai's government.

Neighbor Mohammad Ismail Kohistani was dumbfounded to hear on the radio that Afghan officials were combing Narges' phone records to try to determine whether al Qaeda or the Taliban could have brainwashed her into carrying out a mission.

But he was acutely aware of her mental problems and often heard her scream at her husband, whose low-level job in the crime investigation unit of the police brought home little cash.

Kohistani, who operates a small sewing shop with battered machines, never imagined his neighbor could be accused of a high-profile attack that raised new questions about the direction of an unpopular war.

"I became very depressed and sad," said Kohistani, sitting on the floor few feet from a tiny wood-burning stove in Narges's home, alongside family photographs and a police training manual.

Fatima would often seek refuge in Kohistani's house when her mother's behavior became unbearable. "She did not hate us, but usually she was angry and would not talk to us," said Fatima, her eyes moist with tears.

Nevertheless, she missed her mother. The children were staying with a cousin.

"I ask the government to free my mother, otherwise our future will be destroyed," said Fatima.

Officials described it as another "insider shooting", in which Afghan forces turn on Westerners they are meant to be working with to stabilize the country. There have been over 52 such attacks so far this year.

The shooting at the police headquarters may have alarmed Afghanistan's Western allies. But some Afghans have grown numb to the violence.

Kohistani's 70-year-old father Omara Khan, who sports a white beard, sat twirling prayer beads beneath a photograph of Narges in a black veil beside one of her husband.

Asked what he thought of the attack, he laughed.

"This is common in Afghanistan," said Khan, who lived through decades of upheaval, including the 10-year Soviet occupation and a civil war that destroyed half of Kabul and killed some 50,000 civilians.

"People are killed every day."

(Editing by Ron Popeski)

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British kickboxer charged with Thai murder

BANGKOK: A British kickboxer who was extradited to Thailand could face the death penalty after being charged with the murder of an American Marine on the resort island of Phuket, a court official said.

Prosecutors allege Lee Aldhouse stabbed to death 23-year-old Dashawn Longfellow following a bar fight in 2010.

Aldhouse, known in Phuket by his ring name 'The Pitbull', fled to Britain after the incident and was extradited this month under a 100-year-old treaty, becoming the first British suspect to be returned to Thailand.

"He was indicted on a charge of killing yesterday," said a court official on the popular tourist island.

Aldhouse has been remanded in custody and will return to court to enter a plea on February 18, she said.

He could face the death penalty if convicted, although it is rarely carried out, or up to a life sentence in prison.

Both men are believed to have trained in the Muay Thai form of kickboxing, with local reports saying Aldhouse competed in Phuket. He was 28 at the time of the alleged murder.

Longfellow was in Phuket after sustaining a combat injury in Afghanistan. US media reports said he had been awarded the Purple Heart decoration for his injury.

- AFP/al

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30 dead as cold wave sweeps Uttar Pradesh

LUCKNOW: The cold wave sweeping through Uttar Pradesh has claimed more than 30 lives in a 24-hour span, officials here said on Thursday.

The maximum number of deaths, between Wednesday and Thursday morning, were reported from Bhadohi district where five people succumbed to the cold. As many as four people died in Balia and three each in Allahabad, Mirzapur, Sonebhadra, Ghazipur, Barabanki, Chandauli and Azamgarh districts. Shrawasti and Mau districts have reported one deaths each, a state government official said.

The mercury dropped below four degrees Celsius in most parts of the state even as the day temperatures plummeted below 10 degrees Celsius. Although the thick fog cover has receded in some regions, cold winds continued to add to the troubles of the people.

The Met Office in the state capital Lucknow does not see any respite from the cold weather conditions in coming days. A weather official said the dense fog in the state would make things "far more difficult" in the next few days.

Although the state government has made arrangements of shelter homes and bonfires for the poor and the homeless, 37 people perished after the cold wave conditions set in across the state last week.

The thick fog cover has also hit the rail and air traffic in the state. Many trains were running behind schedule, especially those coming from Punjab, Bihar and Delhi, a railways official said.

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Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

___

Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Egypt approves constitution drafted by Mursi allies

CAIRO (Reuters) - Egyptian voters overwhelmingly approved a constitution drafted by President Mohamed Mursi's allies, results announced on Tuesday showed, proving that liberals, leftists and Christians have been powerless to halt the march of Islamists in power.

Final elections commission figures showed the constitution adopted with 63.8 percent of the vote in the referendum held over two days this month, giving Mursi's Islamists their third straight electoral victory since veteran autocrat Hosni Mubarak was toppled in a 2011 revolution.

Opposition groups had taken to the streets to block what they see as a move to ram through a charter that mixes politics and religion dangerously and ignores the rights of minorities.

Mursi says the text - Egypt's first constitution since Mubarak's fall - offers enough protection for minorities, and adopting it quickly is necessary to end two years of turmoil and political uncertainty that has wrecked the economy.

"I hope all national powers will now start working together now to build a new Egypt," Murad Ali, a senior official in the Muslim Brotherhood's Freedom and Justice Party, told Reuters.

"I see this as the best constitution in Egypt's history."

In a sign that weeks of unrest have taken a further toll on the economy, the government ordered new restrictions on foreign currency apparently designed to prevent capital flight. Leaving or entering with more than $10,000 cash is now banned.

Two years since waves of unrest broke out across the Middle East and North Africa - sweeping away long-entrenched rulers in Tunisia, Libya and Yemen as well as Egypt - well-organized Islamist parties have emerged as the main beneficiaries.

Urban secularists and liberals who were behind the revolts complain that their success has been hijacked.

"We need a better constitution," said Khaled Dawood, an opposition spokesman. "It does not represent all Egyptians."

Mursi's opponents say the new constitution could allow clerics to intervene in lawmaking, while offering scant protections to minorities and women. Mursi dismisses those criticisms, and many Egyptians are fed up with street protest movements that have prevented a return to normality.

Immediately after the announcement, a small group of protesters set tires on fire and blocked traffic near the central Tahrir square, the cradle of Egypt's uprising, but there were no immediate signs of violence or major demonstrations.

Washington, which provides billions of dollars a year in military and other support for Egypt and regards it as a pillar of security in the Middle East, called on Egyptian politicians to bridge divisions and on all sides to reject violence.

"President Mursi, as the democratically elected leader of Egypt, has a special responsibility to move forward in a way that recognizes the urgent need to bridge divisions," State Department spokesman Patrick Ventrell said. He noted that many Egyptians had voiced "significant concerns" over the constitutional process.

WORSENING ECONOMY

The government says its opponents are worsening the economic crisis by prolonging political upheaval. It has pledged to impose unpopular tax increases and spending cuts to win a loan package from the International Monetary Fund.

The ban on travelling with more than $10,000 in cash followed a pledge by the central bank to take unspecified measures to protect Egyptian banks. Some Egyptians have begun withdrawing their savings in fear of more restrictions.

"I am not going to put any more money in the bank and neither will many of the people I know," said Ayman Osama, father of two young children.

He said he had taken out the equivalent of about $16,000 from his account this week and planned to withdraw more, adding that he had also told his wife to buy more gold jewellery.

The "yes" vote paves the way for a parliamentary election in about two months, setting the stage for another battle between surging Islamists and their fractious opponents.

The final result, announced by the election commission, matched - to the last decimal place - an earlier unofficial tally announced by Mursi's Muslim Brotherhood.

But the opposition said it was disappointed - it had appealed for the result to be amended to reflect what it described as major vote violations during the two-round vote.

Officials said there were no violations serious enough to change the result significantly. "We have seriously investigated all the complaints," said judge Samir Abu el-Matti of the Supreme Election Committee. The final turnout was 32.9 percent.

SENSE OF CRISIS

The referendum has sharpened painful divisions in the Arab world's most populous nation and a growing atmosphere of crisis has gripped Egypt's polarized society.

Anxiety about the economy deepened this week when Standard and Poor's cut Egypt's long-term credit rating. Prime Minister Hisham Kandil told the nation of 83 million on Tuesday the government was committed to fixing the economy.

"The main goals that the government is working towards now is plugging the budget deficit, and working on increasing growth to boost employment rates, curb inflation, and increase the competitiveness of Egyptian exports," he said.

The referendum follows Islamist victories in parliamentary and presidential elections, representing a decisive shift in a country at the heart of the Arab world where Mursi's Muslim Brotherhood was suppressed for generations by military rulers.

However, secularist and liberal opposition members hope they can organize better in time for the next parliamentary vote.

Hossam El-Din Ali, a 35-year-old newspaper vendor in central Cairo, said he agreed the new constitution would help bring some political stability but like many others he feared the possible economic austerity measures lying ahead.

"People don't want higher prices. People are upset about this," he said. "There is recession, things are not moving. But I am wishing for the best, God willing."

(Additional reporting by Patrick Werr, Tamim Elyan, Ahmed Tolba and Marwa Awad; Writing by Maria Golovnina)

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Samsung hits back at Ericsson in patent battle

SEOUL: South Korea's Samsung Electronics said on Wednesday it had filed a complaint to seek a US import ban on some Ericsson products in an escalating patent battle with the Swedish mobile giant.

Samsung took the action Friday with the US International Trade Commission, seeking a ban on imports and sales of Ericsson's products over alleged infringements of Samsung's wireless and equipment patents.

"We have sought to negotiate with Ericsson in good faith. However, Ericsson has proven unwilling to continue such negotiations by making unreasonable claims, which it is now trying to enforce in court", Samsung said.

"Under such circumstances, we have no choice but to take the steps necessary to protect our company," it said in a statement.

The action came after Ericsson earlier in the month filed a complaint with the commission seeking a ban on the import of some of Samsung's wireless products, including devices in its Galaxy range.

The pair are currently engaged in a patent dispute in a US district court.

Ericsson claims Samsung is seeking to drastically reduce the fee it pays to license so-called standard essential patents, which protect inventions incorporated into broader technologies used throughout the industry, court filings showed.

Samsung argues Ericsson's fee is too high.

- AFP/ck

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Home ministry announces Rs 10 lakh ex-gratia for family of dead constable Subhash Tomar

NEW DELHI: The home ministry announced on Wednesday an ex-gratia of Rs 10 lakh to the next of kin of Delhi Police constable Subhash Chand Tomar, who died here on Tuesday morning.

An ex-gratia of Rs 10 lakh will be given to the family of Tomar in addition to the financial and other relief announced by the Delhi Police, a home ministry spokesperson said.

The 47-year-old constable, who was injured during violent protests at India Gate on Sunday, died on Tuesday after battling for life in a city hospital.

Tomar was posted in Karawal Nagar area and was called for maintaining law and order at India Gate area during the weekend protests over the gangrape of a 23-year-old girl.

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Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

___

Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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