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.


___


Associated Press reporter Tom Odula contributed to this report.


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Dow falls more than 1 percent

To a black ESPN sports analyst, this is the critical question: Is Robert Griffin III, aka RG III, the black rookie sensation Washington Redskins quarterback, "a brother, or is he a cornball brother?" What has RG III done or said to raise a suspicion about his bona fides as a black person? More importantly, what does this have to do with appreciating — or choosing not to appreciate — Griffin as an athlete?
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Syria to discuss Brahimi peace proposals with Russia


BEIRUT (Reuters) - Syrian President Bashar al-Assad sent a senior diplomat to Moscow on Wednesday to discuss proposals to end the conflict convulsing his country made by international envoy Lakhdar Brahimi, Syrian and Lebanese sources said.


Brahimi, who saw Assad on Monday and is planning to hold a series of meetings with Syrian officials and dissidents in Damascus this week, is trying to broker a peaceful transfer of power, but has disclosed little about how this might be done.


More than 44,000 Syrians have been killed in a revolt against four decades of Assad family rule, a conflict that began with peaceful protests but which has descended into civil war.


Past peace efforts have floundered, with world powers divided over what has become an increasingly sectarian struggle between mostly Sunni Muslim rebels and Assad's security forces, drawn primarily from his Shi'ite-rooted Alawite minority.


Deputy Foreign Minister Faisal Makdad flew to Moscow to discuss the details of the talks with Brahimi, said a Syrian security source, who would not say if a deal was in the works.


However, a Lebanese official close to Damascus said Makdad had been sent to seek Russian advice on a possible agreement.


He said Syrian officials were upbeat after talks with Brahimi, the U.N.-Arab League envoy, who met Foreign Minister Walid Moualem on Tuesday a day after his session with Assad, but who has not outlined his ideas in public.


"There is a new mood now and something good is happening," the official said, asking not to be named. He gave no details.


Russia, which has given Assad diplomatic and military aid to help him weather the 21-month-old uprising, has said it is not protecting him, but has fiercely criticized any foreign backing for rebels and, with China, has blocked U.N. Security Council action on Syria.


"ASSAD CANNOT STAY"


A Russian Foreign Ministry source said Makdad and an aide would meet Foreign Minister Sergei Lavrov and Mikhail Bogdanov, the Kremlin's special envoy for Middle East affairs, on Thursday, but did not disclose the nature of the talks.


On Saturday, Lavrov said Syria's civil war had reached a stalemate, saying international efforts to get Assad to quit would fail. Bogdanov had earlier acknowledged that Syrian rebels were gaining ground and might win.


Given the scale of the bloodshed and destruction, Assad's opponents insist the Syrian president must go.


Moaz Alkhatib, head of the internationally-recognized Syrian National Coalition opposition, has criticized any notion of a transitional government in which Assad would stay on as a figurehead president stripped of real powers.


Comments on Alkhatib's Facebook page on Monday suggested that the opposition believed this was one of Brahimi's ideas.


"The government and its president cannot stay in power, with or without their powers," Alkhatib wrote, saying his Coalition had told Brahimi it rejected any such solution.


While Brahimi was working to bridge the vast gaps between Assad and his foes, fighting raged across the country and a senior Syrian military officer defected to the rebels.


Syrian army shelling killed about 20 people, at least eight of them children, in the northern province of Raqqa, a video posted by opposition campaigners showed.


The video, published by the Syrian Observatory for Human Rights, showed rows of blood-stained bodies laid out on blankets. The sound of crying relatives could be heard in the background.


The shelling hit the province's al-Qahtania village, but it was unclear when the attack had occurred.


STRATEGIC BASE


Rebels relaunched their assault on the Wadi Deif military base in the northwestern province of Idlib, in a battle for a major army compound and fuel storage and distribution point.


Activist Ahmed Kaddour said rebels were firing mortars and had attacked the base with a vehicle rigged with explosives.


The British-based Observatory, which uses a network of contacts in Syria to monitor the conflict, said a rebel commander was among several people killed in Wednesday's fighting, which it said was among the heaviest for months.


The military used artillery and air strikes to try to hold back rebels assaulting Wadi Deif and the town of Morek in Hama province further south. In one air raid, several rockets fell near a field hospital in the town of Saraqeb, in Idlib province, wounding several people, the Observatory said.


As violence has intensified in recent weeks, daily death tolls have climbed. The Observatory reported at least 190 had been killed across the country on Tuesday alone.


The head of Syria's military police changed sides and declared allegiance to the anti-Assad revolt.


"I am General Abdelaziz Jassim al-Shalal, head of the military police. I have defected because of the deviation of the army from its primary duty of protecting the country and its transformation into gangs of killing and destruction," the officer said in a video published on YouTube.


A Syrian security source confirmed the defection, but said Shalal was near retirement and had only defected to "play hero".


Syrian Interior Minister Mohammed Ibrahim al-Shaar left Lebanon for Damascus after being treated in Beirut for wounds sustained in a rebel bomb attack this month.


(Additional reporting by Laila Bassam; Writing by Alistair Lyon; Editing by Andrew Osborn)



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Kim Kardashian Tries a New Hair Color







Style News Now





12/26/2012 at 11:30 AM ET











Kim Kardashian Hair
SPW/Splash News Online. Inset: Startraks


The bangs may have been fake (turns out they were just clip-ins), but Kim Kardashian‘s new hair shade is definitely for real.


Just before Christmas, the reality star decided to go back to her roots — literally — and color her mane a super-deep brown, almost black hue.


For the past few months (while filming Kim and Kourtney Take Miami) the star had been sporting light caramel locks, but Kardashian was clearly ready for a change.


“After Miami I was honestly just soooo over it being light and listened to the suggestions to take my hair back to my natural color!” the star wrote on her website.


Hmm … wonder who it was offering up the suggestions … Her boyfriend and occasional stylist Kanye West, perhaps? After all, he’s supposedly the one responsible for getting her to wear so much black in her wardrobe.


The last time Kardashian had hair this dark was in August, and we’re happy to see her go back to her natural color. Tell us: Do you prefer Kardashian with dark or light hair?


–Jennifer Cress


PHOTOS: SHARE YOUR THOUGHTS ON 2012′s CELEBRITY HAIR MAKEOVERS!




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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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Wall Street sags, "cliff" angst steals retailers' Christmas

NEW YORK (Reuters) - U.S. stocks fell on Wednesday as retailers' shares dropped sharply after a report that showed holiday shoppers were less enthusiastic than last year, with investors saying worries about the "fiscal cliff" may have kept them away from stores.


The Morgan Stanley retail index <.mvr> skidded 1.8 percent as holiday-related sales rose 0.7 percent from October 28 through December 24, compared with a 2 percent increase last year, according to data from MasterCard Advisors SpendingPulse. The SPDR S&P Retail Trust slipped 1.5 percent to 61.24.


Janna Sampson, co-chief investment officer of OakBrook Investments in Lisle, Illinois, said worries about "fiscal cliff" tax hikes and spending cuts next year had likely kept shoppers from a last-minute rush to the stores.


"I think people held back this year, just worried about that bigger cut out of their paycheck next year and having to tighten their belt," she said. "If you've got to tighten your belts starting in January, people start worrying about overspending."


Department stores' stocks slid. Macy's lost 3 percent to $36.41, while Saks also fell 3 percent and traded at $10.30, near its session low. Online retailer Amazon.com fell 3.1 percent to $250.52.


President Barack Obama is due back in Washington early Thursday for a final effort to negotiate a deal with Congress to bridge a series of tax increases and government spending cuts set to begin next week. The president will leave Hawaii later on Wednesday, arriving in the capital early on Thursday.


The Dow Jones industrial average <.dji> slipped 45.61 points, or 0.35 percent, to 13,093.47. The Standard & Poor's 500 Index <.spx> shed 8.66 points, or 0.60 percent, to 1,418. The Nasdaq Composite Index <.ixic> dropped 23.10 points, or 0.77 percent, to 2,989.50.


Volume was light, with only 1.55 billion shares having traded at midday on the New York Stock Exchange, the Nasdaq and the NYSE MKT. Many senior traders were still on vacation during this holiday-shortened week and major European markets were closed for the day.


Still, Wednesday marked the third day of losses for the S&P 500 in its worst three-day decline since mid-November.


A Republican plan that failed to gain traction last week triggered the S&P 500's recent drop, highlighting the market's sensitivity to headlines centered around the budget talks.


"No one is hitting the panic button yet, and part of that lack of panic selling is the notion that the Street is getting comfortable with the likelihood of a temporary fix for the fiscal cliff - something that gets us over the date of January 1 in a way where it can be re-addressed," said Peter Kenny, managing director at Knight Capital in Jersey City, New Jersey.


During the last five trading days of the year and the first two of next year, it's possible for a "Santa rally" to occur. Since 1928, the S&P 500 has averaged a gain of 1.8 percent during that period and risen 79 percent of the time, according to data from PrinceRidge.


The benchmark S&P 500 Index is up 12.8 percent for the year, and has recouped nearly all of the losses after the U.S. elections when the fiscal cliff concerns moved to the forefront. This is the best yearly gain for the S&P 500 since 2010.


Data showed U.S. single-family home prices rose in October, reinforcing the view that the domestic real estate market is improving, as the S&P/Case-Shiller composite index of 20 metropolitan areas gained 0.7 percent in October on a seasonally adjusted basis.


In the energy sector, China's Sinopec Group and ConocoPhillips will research potentially vast reserves of shale gas in southwestern China over the next two years, state news agency Xinhua reported. Conoco's stock fell 0.8 percent to $57.99.


An outage at one of Amazon.com Inc's web service centers hit users of Netflix Inc's streaming video service on Christmas Eve and was not fully resolved until Christmas Day, a spokesman for the movie rental company said on Tuesday. Netflix rose 0.8 percent to $90.97.


(Reporting by Edward Krudy; Editing by Jan Paschal)



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Syria envoy seeks peace as clashes rage


BEIRUT (Reuters) - International envoy Lakhdar Brahimi pursued mediation efforts in Damascus on Tuesday, but there was no pause in the bloodletting as Syrian Christians marked a bleak Christmas Day with prayers for peace.


"We are here in a cave that symbolizes Syria right now," said a priest standing beside a nativity scene in a grotto.


"It is cold here but the door is open to all refugees," he told Syrian state TV. "Amid the hunger, cold and deprivation, we still have hope for peace and love for our country."


More than 44,000 Syrians have been killed since a revolt against President Bashar al-Assad erupted 21 months ago, igniting an increasingly sectarian conflict that broadly pits a Sunni Muslim majority against Assad's Alawite minority.


Christians, many of whom have been reluctant to join what they see as an Islamist-tinged insurgency, feel threatened.


Bishop John Kawak, speaking on state TV, said the Christmas holiday was "a symbol for the rebirth of the nation". He condemned "terrorism", the government's term for the rebellion.


Brahimi met some dissidents who are tolerated by Assad but rejected by the mainstream opposition and by rebels fighting to oust him, a day after he held talks with the Syrian president.


There was no word on any progress in the U.N.-Arab League' envoy's drive to end violence that has intensified in recent months as Assad uses airpower and artillery against rebel gains.


Raja Naser, secretary general of the National Coordination Body, said after meeting Brahimi that the envoy planned a week of meetings in Damascus and would stay until Sunday.


"There is still a lot of concern but there is also great hope that these meetings with other Syrian officials will result in some agreements or positive developments," he said.


But most opposition groups appear frustrated with Brahimi's quest for a deal on a transitional government. He has not clarified any role for Assad, whose foes say he must simply go, arguing that too much blood has been shed for any other outcome.


GULF PLEA


Gulf Arab leaders, who have long called for Assad's removal and some of whom have helped the rebels with guns and money, urged swift world action to halt the "massacres" and violations of international law in Syria.


The pro-opposition Syrian Observatory for Human Rights reported clashes and government shelling in hotspots across the country, including towns on the eastern outskirts of Damascus.


Abu Nidal, a spokesman for the Rebel Military Council in Damascus, said fighters had killed the head of a local security branch in the capital's suburb of Jaramana, home to a large Christian and Druze population.


In his Christmas message to the world on Tuesday, Pope Benedict encouraged Syrians not to lose hope for peace.


"May peace spring up for the people of Syria, deeply wounded and divided by a conflict which does not spare even the defenseless and reaps innocent victims," he said.


"I appeal for an end to the bloodshed, easier access for the relief of refugees and the displaced, and dialogue in the pursuit of a political solution to the conflict."


Hundreds of thousands of Syrians have fled abroad to escape the daily violence. Those who remain face severe shortages of food, fuel and other essentials as winter weather takes a grip.


Syrian activists offered a message of solidarity with Christians despite rising tensions in central Hama province, where rebels have demanded that Christian villages let them enter to force out the army and pro-Assad "shabbiha" militias.


"We say to the Christians, you are our brothers and our beloved, and your holiday is our holiday," said Abu Faisal, a Hama activist who posted a Christmas message on the Internet.


"The rebels are surrounding (the Christian town) Muhardeh to get rid of Assad's soldiers and shabbiha, but we have not forgotten your honorable stance when you took care of our refugees when the army entered Hama," he said.


"We will not accept that you are targeted by hatred, you are our brothers and our friends."


(Additional reporting by Philip Pullela in Vatican City and Asma Alsharif in Manama)



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China may require real name registration for internet access






BEIJING (Reuters) – China may require internet users to register with their real names when signing up to network providers, state media said on Tuesday, extending a policy already in force with microblogs in a bid to curb what officials call rumors and vulgarity.


A law being discussed this week would mean people would have to present their government-issued identity cards when signing contracts for fixed line and mobile internet access, state-run newspapers said.






“The law should escort the development of the internet to protect people’s interest,” Communist Party mouthpiece the People’s Daily said in a front page commentary, echoing similar calls carried in state media over the past week.


“Only that way can our internet be healthier, more cultured and safer.”


Many users say the restrictions are clearly aimed at further muzzling the often scathing, raucous – and perhaps most significantly, anonymous – online chatter in a country where the Internet offers a rare opportunity for open debate.


It could also prevent people from exposing corruption online if they fear retribution from officials, said some users.


It was unclear how the rules would be different from existing regulations as state media has provided only vague details and in practice customers have long had to present identity papers when signing contracts with internet providers.


Earlier this year, the government began forcing users of Sina Corp’s wildly successful Weibo microblogging platform to register their real names.


The government says such a system is needed to prevent people making malicious and anonymous accusations online and that many other countries already have such rules.


“It would also be the biggest step backwards since 1989,” wrote one indignant Weibo user, in apparent reference to the 1989 pro-democracy protests bloodily suppressed by the army.


Chinese internet users have long had to cope with extensive censorship, especially over politically sensitive topics like human rights, and popular foreign sites Facebook, Twitter and Google-owned YouTube are blocked.


Despite periodic calls for political reform, the ruling Communist Party has shown no sign of loosening its grip on power and brooks no dissent to its authority.


(Reporting by Ben Blanchard and Huang Yan; Editing by Michael Perry)


Tech News Headlines – Yahoo! News





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Jessica Simpson Confirms: I'm Pregnant Again!




Celebrity Baby Blog





12/25/2012 at 12:15 PM ET



Jessica Simpson Expecting Second Child
Courtesy Jessica Simpson; Jamie McCarthy/WireImage


It’s official: the stork is once again headed to Jessica Simpson‘s house!


Just seven months after the singer and actress delivered daughter Maxwell Drew, Simpson and fiancĂ© Eric Johnson are expecting their second child, the couple announced via Twitter Christmas Day.


Amid growing pregnancy speculation online, the Fashion Star mentor, 32, shared a photo of her baby girl wearing holiday pajamas and smiling in the sand atop the words, “BIG SIS.”


“Merry Christmas from my family to yours!” Simpson writes.

Recently, Simpson has been spotted around Los Angeles in loose-fitting clothing. She also appeared, in a figure-hugging black dress, at best friend Cacee Cobb‘s recent wedding to Donald Faison, where she served as maid of honor.
Simpson also had been touting her recent post-pregnancy weight loss of 60 lbs. after starring in commercials for Weight Watchers and working out with celebrity trainer Harley Pasternak.


– Andrea Billups and Sarah Michaud


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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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