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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Woman Tied to Gun in NY Firefighter Ambush

Authorities have charged a woman for allegedly providing a convicted killer with the Bushmaster AR-15 assault rifle he used when he ambushed four volunteer firefighters and an off-duty cop at a fire scene in upstate New York on Christmas Eve, federal prosecutors said.

Dawn Nguyen, 24, was arrested today after allegedly making an illegal purchase of the weapon used by William Spengler, 62, who set a house and car on fire in Webster, N.Y., the morning of Dec. 24, then shot dead two firemen and himself.

Nguyen is facing federal and state charges for acting as a "straw purchaser," buying the Bushmaster assault weapon as well as a shotgun with the intention of giving it to someone who cannot legally purchase it himself, said U.S. Attorney William J. Hochul.

Authorities accuse Nguyen of lying about being the sole owner of the weapons when making the purchase, a violation of federal law.

As an ex-convict, Spengler could not have legally owned or purchased the weapons himself.

"Dawn Nguyen told the seller of these weapons that she was to be true owner and buyer of these guns," said Hochul. "It is absolutely against federal law to provide any materially false information" on a firearms application.

As Hochul announced the charges, Nguyen was in a nearby court. It was unknown whether she entered a plea, and her lawyer could not be immediately contacted.

In addition to the rifle and shotgun, Spengler was found with a pistol, which authorities believe he used to kill himself by shooting himself in the head.

After apparently setting the fires, Spengler began shooting at emergency responders, officials have said. The attack left two firefighters and the gunman dead, and two other firefighters hospitalized.

Police officer John Ritter recieved shrapnel injuries at the scene but was discharged quickly from the hospital.

In a typewritten note found at the scene, Spengler revealed that he obtained the weapons from Nguyen, who for a time lived next door to him in Webster, Hochul said.

In that same note, Spengler pledged to see "how much of the neighborhood I can burn down." He said he wanted to "do what I like doing best, killing people."

Police said Spengler set a "trap" in order to ambush the first responders.

Firefighters Michael Chiapperini and Tomasz Kaczowka were gunned down. Two other firefighters, Joseph Hofsetter and Theodore Scardino, remained in guarded condition at a Rochester, N.Y. hospital.

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Syria opposition leader rejects Moscow invitation

ALEPPO PROVINCE, Syria/BEIRUT (Reuters) - Syria's opposition leader has rejected an invitation from Russia for peace talks, dealing another blow to international hopes that diplomacy can be resurrected to end a 21-month civil war.

Russia, President Bashar al-Assad's main international protector, said on Friday it had sent an invitation for a visit to Moaz Alkhatib, whose six-week-old National Coalition opposition group has been recognized by most Western and Arab states as the legitimate voice of the Syrian people.

But in an interview on Al Jazeera television, Alkhatib said he had already ruled out such a trip and wanted an apology from Moscow for its support for Assad.

"We have clearly said we will not go to Moscow. We could meet in an Arab country if there was a clear agenda," he said.

"Now we also want an apology from (Russian Foreign Minister Sergei) Lavrov because all this time he said that the people will decide their destiny, without foreign intervention. Russia is intervening and meanwhile all these massacres of the Syrian people have happened, treated as if they were a picnic."

"If we don't represent the Syrian people, why do they invite us?" Alkhatib said. "And if we do represent the Syrian people why doesn't Russia respond and issue a clear condemnation of the barbarity of the regime and make a clear call for Assad to step down? This is the basic condition for any negotiations."

With the rebels advancing steadily over the second half of 2012, diplomats have been searching for months for signs that Moscow's willingness to protect Assad is faltering.

So far Russia has stuck to its position that rebels must negotiate with Assad's government, which has ruled since his father seized power in a coup 42 years ago.

"I think a realistic and detailed assessment of the situation inside Syria will prompt reasonable opposition members to seek ways to start a political dialogue," Lavrov said on Friday.

That was immediately dismissed by the opposition: "The coalition is ready for political talks with anyone ... but it will not negotiate with the Assad regime," spokesman Walid al-Bunni told Reuters. "Everything can happen after the Assad regime and all its foundations have gone. After that we can sit down with all Syrians to set out the future."

BRAHIMI TO MOSCOW

Russia says it is behind the efforts of U.N. mediator Lakhdar Brahimi, fresh from a five-day trip to Damascus where he met Assad. Brahimi, due in Moscow for talks on Saturday, is touting a months-old peace plan for a transitional government.

That U.N. plan was long seen as a dead letter, foundering from the outset over the question of whether the transitional body would include Assad or his allies. Brahimi's predecessor, Kofi Annan, quit in frustration shortly after negotiating it.

But with rebels having seized control of large sections of the country in recent months, Russia and the United States have been working with Brahimi to resurrect the plan as the only internationally recognized diplomatic negotiating track.

Russia's Middle East envoy, Deputy Foreign Minister Mikhail Bogdanov, who announced the invitation to Alkhatib, said further talks were scheduled between the "three B's" - himself, Brahimi and U.S. Undersecretary of State William Burns.

Speaking in Damascus on Thursday, Brahimi called for a transitional government with "all the powers of the state", a phrase interpreted by the opposition as potentially signaling tolerance of Assad remaining in some ceremonial role.

But such a plan is anathema to the surging rebels, who now believe they can drive Assad out with a military victory, despite long being outgunned by his forces.

"We do not agree at all with Brahimi's initiative. We do not agree with anything Brahimi says," Colonel Abdel-Jabbar Oqaidi, who heads the rebels' military council in Aleppo province, told reporters at his headquarters there.

Oqaidi said the rebels want Assad and his allies tried in Syria for crimes. Assad himself says he will stay on and fight to the death if necessary.

In the rebel-held town of Kafranbel, demonstrators held up cartoons showing Brahimi speaking to a news conference with toilet bowls in front of him, in place of microphones. Banners denounced the U.N. envoy with obscenities in English.

DIPLOMATS IMPOTENT

Diplomacy has largely been irrelevant to the conflict so far, with Western states ruling out military intervention like the NATO bombing that helped topple Libya's Muammar Gaddafi last year, and Russia and China blocking U.N. action against Assad.

Meanwhile, the fighting has grown fiercer and more sectarian, with rebels mainly from the Sunni Muslim majority battling Assad's government and allied militia dominated by his Alawite sect, an offshoot of Shi'ite Islam.

Still, Western diplomats have repeatedly touted signs of a change in policy from Russia, which they hope could prove decisive, much as Moscow's withdrawal of support for Serbian leader Slobodan Milosevic heralded his downfall a decade ago.

Bogdanov said earlier this month that Assad's forces were losing ground and rebels might win the war, but Russia has since rowed back, with Lavrov last week reiterating Moscow's position that neither side could win through force.

Still, some Moscow-based analysts see the Kremlin coming to accept it must adapt to the possibility of rebel victory.

"As the situation changes on the battlefield, more incentives emerge for seeking a way to stop the military action and move to a phase of political regulation," said Dmitry Trenin, director of the Carnegie Moscow Center.

Meanwhile, on the ground the bloodshed that has killed some 44,000 people continues unabated. According to the pro-opposition Syrian Observatory for Human Rights, a monitoring group based in Britain, 150 people were killed on Thursday, a typical toll as fighting has escalated in recent months.

Government war planes bombarded the town of Assal al-Ward in the Qalamoun district of Damascus province for the first time, killing one person and wounding dozens, the observatory said.

In Aleppo, Syria's northern commercial hub, clashes took place between rebel fighters and army forces around an air force intelligence building in the Zahra quarter, a neighborhood that has been surrounded by rebels for weeks.

(Additional reporting by Omar Fahmy in Cairo, Dominic Evans in Beirut and Steve Gutterman and Alissa de Carbonnel in Moscow; Writing by Peter Graff; Editing by Giles Elgood)

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Oil prices decline on 'fiscal cliff' deal doubts

NEW YORK: Oil prices declined Thursday amid doubts that an 11th-hour deal on the "fiscal cliff" crisis could be reached by a rapidly approaching end-of-year deadline.

New York's main contract, West Texas Intermediate (WTI) for February delivery, slipped 11 cents to settle at $90.87 a barrel.

Brent North Sea crude for February delivery dipped 27 cents to $110.80 a barrel in London trade.

With the clock ticking, the White House and Republican lawmakers have yet to reach a deal to keep the United States from falling off the so-called fiscal cliff, a combination of steep tax hikes and drastic spending cuts set to kick in next month.

President Barack Obama cut short his family Christmas break in Hawaii to return to Washington in a last-ditch attempt at reaching a compromise.

But the situation remained tense, with Senate Majority Leader Harry Reid, a Democrat, saying Thursday "it looks like" the US economy will hurtle over the fiscal cliff because House Speaker John Boehner and Republican Minority Leader Mitch McConnell were stalling.

Crude oil prices were "being taken down on what appears to be the growing eventuality that the US is going to go over the fiscal cliff," said analyst John Kilduff of Again Capital.

There was "no doubt that the tax hikes and the spending cuts that will roll automatically will be a real drag on the economy for the us," he added.

Experts warn that going over the "fiscal cliff" could take the United States back into recession. And that could hurt oil demand in the world's biggest consumer of crude.

-AFP/ac

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Oriya author Prathiba Ray to get 47th Jnanpith award

NEW DELHI: The Jnanpith Selection Board (JSB) on Thursday announced Oriya author Prathiba Ray's name for the 47th Jnanpith award for 2011.

The decision was announced after a JSB meeting that noted scholar, writer and Jnanpith award winner Sitakant Mahapatra chaired.

Born in 1943, Ray is one of the widely-read Oriya novelists and short story writers, a JSB communique said. "Her novels and stories are deeply and persuasively grounded in the great tradition of story-telling which brings characters and situations alive. She has a unique skill in developing the themes without being pretentious,'' it said.
Ray, who got Padma Shri in 2007, has 20 novels, 24 short stories' collections, 10 travelogues, two poetry collections besides a number of essays to her credit.

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Utah Teachers Flock to Gun Training

The perception of schools as sanctuaries from violence has been "blown up" by recent events and some believe it's time for educators to literally take the situation into their own hands and carry guns.

"We've had this unwritten code, even among criminals, that schools are off limits. Those are our kids. You don't mess with that," Utah Shooting Sports Council (USSC) Chairman Clark Aposhian told ABCNews.com today.

"That perception has been blown away now," he said. "It's been shattered and if there's one thing that parents across the country are united on, it's that they are committed to and serious about protecting their kids."

Aposhian spoke shortly before opening a weapons training class for teachers and school employees that drew more than 200 Utah educators organized by the USSC, a leading gun lobby group that believes that teachers should be able to fight back when faced with an armed intruder.

"One firearm in the hands of one teacher could have made the difference at Sandy Hook or Columbine, but they weren't allowed to carry in those schools," Aposhian said.

The USSC is waiving its normal $50 training fee today for teachers who wish to attend. Aposhian said the 200 person course was filled to capacity and said he plans on holding another session for people he may have to turn away today.

INFOGRAPHIC: Gun in America: By The Numbers

"We trust these teachers to be with our kids for 8 to 10 hours a day every day," Aposhian said. "I don't think it's a far reach to think that we could think that they would act responsibly and with decorum in protecting their own lives and the lives of the kids under their care."

Gun Owners Give Back: LA Residents Return Guns After Newtown Tragedy Watch Video

The idea of armed teachers has been part of a fiery debate on gun control following the rampage at Connecticut's Sandy Hook Elementary School that left 20 children and six adults dead on Dec. 14.

Utah is one of only a handful of states, including Oregon, Hawaii and New Hampshire, that allow people to carry licensed concealed weapons into public schools. It is not known how many Utah teachers carry guns in public schools because the records are not public.

But Aposhian said that he tells detractors that Utah has not had any school shootings or accidental shootings in the approximately 12 years the law has been in effect.

In Ohio, the Buckeye Firearms Association is launching a pilot armed teacher training program in which 24 teachers will be selected to attend a three-day training class.

Arizona's Attorney General Tom Horne has proposed a state law amendment that would allow one educator in each school to carry a gun.

During today's six-hour training session, the educators will be taught about gun safety, loading and unloading, manipulating the firearm, how to clear malfunctions, use of force laws and state and federal firearm laws.

The training sessions normally draw about 15 to 20 people, Aposhian said, but many of the teachers who have signed up for today have expressed strong feelings about attending the class.

"I think it runs the gamut from passive desire to get a permit because they thought about it here and there to a fervor given the recent events," Aposhian said. "Perhaps they've had an epiphany of sorts and realized that that sanctuary they work in, or at least the perceived sanctuary, isn't all that safe."

The Utah State Board of Education Chair Debra Roberts released the following statement today on the matter:

"The Utah State Board of Education expresses sympathy to all involved in the recent school shooting in Connecticut. In the face of this terrible tragedy, as schools move forward in taking measures to ensure the safety of students and school personnel, we urge caution and thoughtful consideration."

The statement noted that its schools have emergency plans to handle such situations.

Carol Lear, the board's director of school law and legislation, was more blunt about Aposhian's gun training, telling the Associated Press, "It's a terrible idea...It's a horrible, no-good, rotten idea."

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Russia's Putin signals he will sign U.S. adoption ban

MOSCOW (Reuters) - President Vladimir Putin signaled on Thursday he would sign into law a bill barring Americans from adopting Russian children and sought to forestall criticism of the move by promising measures to better care for his country's orphans.

In televised comments, Putin tried to appeal to people's patriotism by suggesting that strong and responsible countries should take care of their own and lent his support to a bill that has further strained U.S.-Russia relations.

"There are probably many places in the world where living standards are higher than ours. So what, are we going to send all our children there? Maybe we should move there ourselves?" he said, with sarcasm.

Parliament gave its final approval on Wednesday to the bill, which would also introduce other measures in retaliation for new U.S. legislation which is designed to punish Russians accused of human rights violations.

For it to become law Putin needs to sign it.

"So far I see no reason not to sign it, although I have to review the final text and weigh everything," Putin said at a meeting of federal and regional officials that was shown live on the state's 24-hour news channel.

"I intend to sign not only the law ... but also a presidential decree that will modify the support mechanisms for orphaned children ... especially those who are in a difficult situation, by that I mean in poor health," Putin said.

Critics of the bill say the Russian authorities are playing political games with the lives of children, while the U.S. State Department repeated its "deep concern" over the measure.

"Since 1992 American families have welcomed more than 60,000 Russian children into their homes, and it is misguided to link the fate of children to unrelated political considerations," State Department spokesman Patrick Ventrell said in a statement.

Ventrell added that the United States was troubled by provisions in the bill that would restrict the ability of Russian civil society organizations to work with U.S. partners.

Children in Russia's crowded and troubled orphanage system - particularly those with serious illnesses or disabilities - will have less of a chance of finding homes, and of even surviving, if it becomes law, child rights advocates say.

They point to people like Jessica Long, who was given up shortly after birth by her parents in Siberia but was raised by adoptive parents in the United States and became a Paralympic swimming champion.

However, the Russian authorities point to the deaths of 19 Russian-born children adopted by American parents in the past decade, and lawmakers named the bill after a boy who died of heat stroke in Virginia after his adoptive father left him locked in a car for hours.

Putin reiterated Russian complaints that U.S. courts have been too lenient on parents in such cases, saying Russia has inadequate access to Russian-born children in the United States despite a bilateral agreement that entered into force on November 1.

NATIONAL IDENTITY

But Putin, who began a new six-year term in May and has searched for ways to unite the country during 13 years in power, suggested there were deeper motives for such a ban.

"For centuries, neither spiritual nor state leaders sent anyone abroad," he said, indicating he was not speaking specifically about Russia but about many societies.

"They always fight for their national identities - they gather themselves together in a fist, they fight for their language, culture," he said.

The bid to ban American adoptions plays on sensitivity in Russia about adoptions by foreigners, which skyrocketed as the social safety net unraveled with the 1991 Soviet collapse.

Families from the United States adopt more Russian children than those of any other country.

Putin had earlier described the Russian bill as an emotional but appropriate response to the Magnitsky Act, legislation signed by President Barack Obama this month as part of a law granting Russia "permanent normal trade relations" (PNTR) status.

The U.S. law imposes visa bans and asset freezes on Russians accused of human rights violations, including those linked to the death in a Moscow jail of Sergei Magnitsky, an anti-graft lawyer, in 2009.

The Russian bill would impose similar measures against Americans accused of violating the rights of Russian abroad and outlaw some U.S.-funded non-governmental groups.

(Reporting By Alexei Anishchuk; additional reporting by Andrew Quinn in Washington; Writing by Alissa de Carbonnel and Steve Gutterman; Editing by Andrew Osborn and Doina Chiacu)

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Pakistan to mark five years since Bhutto murder

LARKANA, Pakistan: Pakistan Thursday marks the fifth anniversary of the assassination of former prime minister Benazir Bhutto, with her son expected to launch his political career with a speech in the family's ancestral home town.

Bhutto, twice elected prime minister, was killed in a gun and suicide attack after an election rally in Rawalpindi, the headquarters of Pakistan's army, on December 27, 2007. No one has ever been convicted of her murder.

Thousands are expected to gather at the Bhutto family mausoleum at Larkana in the southern province of Sindh and Bilawal Bhutto Zardari, the son of Benazir and of President Asif Ali Zardari, is to make his first major public speech.

The Bhutto family has been a force in Pakistani politics for almost all of the country's 65-year history.

Benazir's father Zulfikar Ali Bhutto led the country from 1971 until he was ousted in a military coup in 1977. He was hanged in 1979 after being convicted of authorising the murder of a political opponent.

With a general election due in the spring, analysts say the ruling Pakistan People's Party (PPP) is eager to introduce a third generation of the dynasty to the public.

"It appears to be the formal launching of Bilawal Bhutto Zardari into politics," political analyst Hasan Askari told AFP.

"Bilawal has symbolic value in the Bhutto family and Zardari would like this link to be used as symbolism in the election."

As head of state President Zardari, who came to power in elections held a month after his wife's murder, is barred from leading the PPP election campaign. He is also hugely unpopular, tainted by years of corruption allegations.

Though the 24-year-old Bilawal will be too young to stand if elections go ahead as expected in the spring -- the lower age limit is 25 -- Askari said he could provide a fresh new figurehead for the PPP campaign.

Bilawal, co-chairman of the PPP with his father, in May accused former military ruler Pervez Musharraf of "murdering" his mother by deliberately sabotaging her security.

A UN report in 2010 also said the murder could have been prevented and accused Musharraf's government of failing to protect Bhutto properly.

The Musharraf regime blamed the assassination on Pakistani Taliban chief Baitullah Mehsud, who denied any involvement and was killed in a US drone attack in August 2009.

There has been a surge in terror attacks in Pakistan in the past weeks. Brigadier Saad Khan, a former officer with the powerful Inter-Services Intelligence agency, warned the Taliban may continue their campaign with an attack on events marking the anniversary.

-AFP/ac

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Manmohan congratulates Japan's new PM Shinzo Abe

NEW DELHI: Prime Minister Manmohan Singh on Wednesday congratulated Shinzo Abe, the new PM of Japan, on the victory of his Liberal Democratic Party in the general elections recently held in Japan. The PM underlined the importance of the strategic and global partnership between India and Japan and noted that Abe has been a key architect of this partnership, sources said.

He emphasized that the bilateral relationship between the two countries is of immense importance to ensure peace, stability and prosperity in the region and the world. He also noted that the rapid growth in the bilateral economic engagement (through trade, investment and flagship projects) has brought rich dividends to both the countries.

Singh expressed confidence that Japan's economy will further prosper and Japan will play an important role in the world affairs under his leadership and emphasized on working with him for further strengthening India's relations with Japan.

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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.

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Online:

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

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

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