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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Media may argue against redactions in church files, judge rules









Media organizations will be allowed to argue against redactions in secret church files that are due to be made public as part of a historic $660-million settlement between the Los Angeles Archdiocese and alleged victims of sexual abuse by priests, a Los Angeles County Superior Court judge ruled Thursday.


Pursuant to Judge Emilie Elias' order, The Times and the Associated Press will be allowed to intervene in the case, in which attorneys are gearing up for the release of internal church personnel documents more than five years after the July 2007 settlement. The judge's ruling came after attorneys for the church and the plaintiffs agreed to the news organizations' involvement in the case.


The Times and the AP object to a portion of a 2011 decision by a retired judge overseeing the file-release process. Judge Dickran Tevrizian had ruled that all names of church employees, including Cardinal Roger M. Mahony and other top archdiocese officials, should be blacked out in the documents before they were made public. In a hearing, Tevrizian said he did not believe the documents should be used to "embarrass or to ridicule the church."





Attorneys for the news organizations argued in court filings that the redactions would "deny the public information that is necessary to fully understand the church's knowledge about the serial molestation of children by priests over a period of decades." The personnel files of priests accused of molestation, which a church attorney has said were five or six banker's boxes of documents, could include internal memos about abuse claims, Vatican correspondence and psychiatric reports.


Contending that the secrecy was motivated by "a desire to avoid further embarrassment" for the church rather than privacy concerns, the media attorneys wrote: "That kind of self-interest is not even remotely the kind of 'overriding interest' that is needed to overcome the public's presumptive right of access, nor does it establish 'good cause' for ongoing secrecy."


An archdiocese attorney said Thursday that the church had spent a "great deal of effort" in redacting the files to comply with Tevrizian's order, and said the media attorneys misunderstand the legal process that both parties in the settlement agreed would be binding.


"We agree with Judge Tevrizian that enough time has passed and enough reforms have been made that it's time to get off this and move onto another subject," attorney J. Michael Hennigan said.


An attorney representing the victims also filed papers Thursday arguing that the church was "too broadly construing" Tevrizian's redaction orders, and asking Elias to release the files with church officials' names unredacted.


"Each of the higher-ups in the Los Angeles Archdiocese who recklessly endangered generations of this community's children by protecting pedophile priests will themselves be protected," wrote Ray Boucher, lead attorney for the plaintiffs.


A hearing on the release of church documents is scheduled for Jan. 7. At the hearing, Elias will also hear objections from an attorney representing individual priests, who contend that their constitutional privacy rights will be violated if the files are made public. In a court filing this month, the priests' attorney, Donald Steier, said Tevrizian was "dead wrong" to rule that the documents can be disclosed because the public interest outweighs the clerics' rights.


"Under California law, it is the employees who own the information in the files, and the Archdiocese is merely the custodian who has a legal duty to defend the contents of the files and has no legal right to agree to disclose them," Steier wrote.


victoria.kim@latimes.com





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IHT Rendezvous: IHT Quick Read: Dec. 27

NEWS China began service Wednesday morning on the world’s longest high-speed rail line, from Beijing to Guangzhou — covering a distance in eight hours that is about equal to that from New York to Key West, Florida, or from London across Europe to Belgrade, Serbia. Keith Bradsher reports from Hong Kong.

Syria’s embattled leadership suffered a new setback Wednesday with the defection of its military police chief, the highest-ranking officer to abandon President Bashar al-Assad since the uprising against him began nearly two years ago. Kareem Fahim and Rick Gladstone report.

On the outskirts of Rome is an abandoned building colloquially known as the Salaam Palace, once a sparsely populated shelter where new arrivals from Africa squatted to create their own refuge. Today more than 800 refugees live there, a vivid reminder of what many say is Italy’s failure to assist and integrate those who have qualified for asylum under its laws. Elisabetta Povoledo reports from Rome.

Japan’s Parliament formally chose the nationalist ex-prime minister Shinzo Abe to lead the country again, ending a three-year break from decades of near-constant rule by his conservative Liberal Democratic Party. Martin Fackler reports from Tokyo.

ARTS On Indian television, mothers-in-law are not a joke — they’re the law. In soap operas as in life, the extended family is still the bedrock of Indian society, where modernization meets its match. Alessandra Stanley reports from Mumbai.

The new Stedelijk Museum in Amsterdam — shaped like a bathtub, of all things — arrives years behind schedule at the tail end of the money-fueled, headline-hungry, erratically ingenious era of indulgent museum design that began to peter out with the global economy. Why a tub? That, says Michael Kimmelman, is the $170 million (well over budget) question.

SPORTS The resurgence of German soccer began, like the country’s economic comeback, after a long slide toward stagnation amid dire prophecies of impending irrelevance. Since then Germany has invested nearly $1 billion in its youth soccer programs, and the products of the new factory system were exhibited in striking fashion this season. Nicholas Kulish reports.

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Kate Winslet Marries in Secret















12/26/2012 at 09:10 PM EST



Talk about a Titanic secret.

Kate Winslet has tied the knot with Richard Branson's nephew, Ned Rocknroll, her rep tells PEOPLE.

"I can confirm that Kate Winslet married Ned Rock'nRoll in NY earlier this month in a private ceremony attended by her two children and a very few friends and family," the rep says. "The couple had been engaged since the summer."

According to British media reports, Leonardo DiCaprio gave away the bride in a ceremony so secret that the bride and groom's parents didn't know about it.

The Oscar-, Golden Globe- and Emmy-winning actress, 37, has been dating Rocknroll, 34, (his legal name) since fall of 2011.

In August 2011, she and Rocknroll were on the same Caribbean island owned by Branson when a fire broke out and Winslet rescued Branson's 90-year-old mother.

Winslet previously was married to Sam Mendes and Jim Threapleton.

Reporting by JULIE JORDAN

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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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Getting the Rose Bowl ready for game time









College football coaches won't be the only ones calling the shots at the Rose Bowl on Jan. 1.


Dozens of Tournament of Roses Assn. workers are now planning every game detail, including the timing of the traditional B-2 flyover and the toss of a specially minted silver coin to determine who will receive the kickoff. The busiest invisible hands belong to Tournament of Roses senior game manager Edward Corey and game manager Ted Tompkins.


Corey, prepping for his 35th Rose Bowl, coordinates each moment from the sidelines. When the college bands start to play, it's because Corey said go.





TIMELINE: College football 2012-13 bowl schedule


Tompkins, 59, must have everyone and everything in place for Corey. Praised by Rose Bowl Game Chief Administrative Officer Kevin Ash as the organization's top playmaker on the fly, Tompkins stands ready with spare coins for the toss and contingency plans in mind for potential miscues. This will be his 40th Rose Bowl.


"Our goal is not to be seen," said Corey, 51. "Our jobs are done best if no one knows we're here."


The Rose Bowl Game is traditionally played between the champions of what are now the Pac-12 and Big Ten conferences, based on an agreement brokered for the 1948 matchup.


Planning starts in August, when Tournament of Roses leaders meet with conference officials. Efforts kick into high gear after the participating teams are announced in early December. Only then can workers design stadium banners, create and distribute tickets, order merchandise, coordinate team itineraries and obtain stencils and paint for field decals.


Even the Rose Bowl grass is grown anew. The playing field the UCLA Bruins used for their last game of the season Nov. 24 has been replaced as the Wisconsin Badgers and Stanford Cardinal prepare for their showdown.


"The first time this turf's played on is Jan. 1. The Tournament wants the first impression to be 'Wow,'" said Corey, who lives in South Pasadena.


Workers began painting the end zones and marking lines on Wednesday. Artwork gets two coats of paint and a final touch-up a few days before the game, said field assistant Miguel Yepez.


Tompkins, a La Crescenta resident, is responsible for herding players and coaches to news conferences and driving the Rose Queen, the grand marshal and the Tournament president from a Rose Parade tailgate tent to the stadium.


All the while, Corey is marking the time until the 2:04 p.m. flyover and 2:10 p.m. kickoff.


"I'm on a headset with [announcer Chuck White], and if I see we have more time, he'll read slower or put a video on the board. We're basically playing with the script the entire time," Corey said.


joe.piasecki@latimes.com





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Egypt’s Hamdeen Sabahi vs. Islamists and Free Markets





CAIRO — Hamdeen Sabahi was the most popular leader in the fight against Egypt’s new Islamist-backed constitution. Now he is preparing for his next battle: against Islamist leaders’ plans for Western-style free-market reforms.




Do not listen to your allies in the Muslim Brotherhood, Mr. Sabahi said he warned President Mohamed Morsi, of the Brotherhood’s political arm, in a private meeting a few weeks ago. “Because the Brotherhood’s economic and social thought is the same as Mubarak’s: the law of the markets,” Mr. Sabahi said he had told Mr. Morsi, referring to Hosni Mubarak, the former president. “You will just make the poor poorer, and they will be angry with you just as they were with Mubarak.”


Mr. Sabahi, a leftist in the style of another former president, Gamal Abdel Nasser, frightens most economists. He is an outspoken opponent of free-market economic moves in general as well as of a pending $4.5 billion loan from the International Monetary Fund that economists say is urgently needed to avert a catastrophic currency collapse.


But to the dismay of some Western diplomats, Mr. Sabahi is emerging as an increasingly salient voice in Egyptian politics, in part because of the bruising race to ratify the Islamist-backed charter. Both sides now expect the anti-Islamist opposition to reap big gains in the coming parliamentary vote, set to be held in two months against the backdrop of a simultaneous debate over the I.M.F. loan.


Among Egypt’s opposition figures, Mr. Sabahi has the biggest base of support in the streets. After campaigning as a dark horse in the spring’s presidential election, he missed the runoff by fewer than a million votes, finishing the first round almost neck and neck with Mr. Morsi.


Economic overhaul now poses a critical test of Egypt’s fragile democracy. Without enough trust in government, the changes to the systems of taxes or subsidies needed to reduce the deficit could easily stir new unrest in the streets, just as such moves have in the past. But if Mr. Morsi expects his opponents to hold their fire just because economists say the need is dire, Mr. Sabahi said, the president should think again.


“Why support him, for what?” Mr. Sabahi said in an interview in the borrowed offices of an Egyptian film director, decorated with pictures of President Nasser but also of Che Guevara. “Is he a democratic ruler, is he a revolutionary? Is he a model of a president, so I want him to succeed?”


Mr. Sabahi, 58, known for writing poetry and quoting Arab literature and for his blow-dried hair, was one of the few non-Islamist politicians willing to endure imprisonment alongside the members of the Muslim Brotherhood in the struggle against Egypt’s autocracy, giving him a unique credibility among more secular leaders.


But after missing the presidential runoff this year, Mr. Sabahi declined to endorse either Mr. Morsi or his opponent, Ahmed Shafik, a former Mubarak prime minister. It was a choice between “tyranny in the name of the state” and “tyranny in the name of religion,” Mr. Sabahi said at the time in a television interview.


Mr. Sabahi argued in the interview that although Mr. Morsi won election democratically, he has failed to govern as a democrat. “He is kicking away the ladder he climbed,” Mr. Sabahi said, arguing that Mr. Morsi’s decree setting his authority above the courts, if only for a month, ended his credibility as a democrat.


The resulting discord between the Islamists and their opponents has postponed the I.M.F. loan and helped bring Egypt closer than ever to economic collapse. State media on Tuesday described a “dollarization frenzy” gripping the country as people raced to sell Egyptian pounds. The currency is at its lowest level in the past eight years.


Since Mr. Mubarak’s ouster, Egypt’s hard currency reserves have fallen to $15 billion from $43 billion as it has struggled to prop up the pound, and economists say the government now urgently needs a cash infusion of about $14 billion in order to stay afloat. The $4.5 billion I.M.F. loan is expected to act as a seal of approval for others, after the I.M.F. concludes Egypt is at least on a path to greater balance.


If that loan does not come through soon, “the risk is a disaster,” said Heba Handoussa of the Economic Research Forum. “We can’t afford to wait.”


There are other more Western-friendly faces of the opposition, like Mohamed ElBaradei, the former United Nations diplomat, and Amr Moussa, the former foreign minister. But neither has Mr. Sabahi’s following at the grass roots, and he speaks for a segment of the Egyptian public deeply suspicious of free markets and, especially, the I.M.F. A popular singer, El Manawahly, has even recorded a song and music video opposing the loan. “Oh monetary fund / Show me how to industrialize, plant and kneel.”


Mayy El Sheikh contributed reporting.



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Huawei shows off 6.1-inch Android phablet ahead of CES [video]









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Giada De Laurentiis: My Daughter Still Believes in Santa

Giada De Laurentiis Jade Still Believes in Santa
Courtesy Giada De Laurentiis


The tree’s done. The stockings are hung. Giada De Laurentiis and her family — husband Todd Thompson and their daughter Jade Marie — are officially ready to host the holidays.


“Christmas Eve is the big tradition in an Italian family. It’s when my entire family gets together,” the newest face of Clairol tells PEOPLE exclusively.


“This year, for the first time, it will be held at my house … so Jade and I and my husband are very excited.”


On the menu for the family festivities is “a big fish dinner,” one that no doubt Jade will help her mother to prepare. After all, adds the celebrity chef, she is the unofficial taste tester.


“My daughter loves to cook. We have a lot of laughs together. I spend a lot of time in the kitchen and she loves hanging out with me,” De Laurentiis, 42, shares. “The reason she loves it so much is because she can stick her finger in everything and taste it as she goes along.”

Once the big dinner is done with, and the evening starts to wind down, De Laurentiis and Jade will start to prepare for the night’s biggest guest to arrive: Santa Claus. At 4½-years-old, her little girl is still a strong believer in the magic of it all, notes her proud mama.


“She leaves him little treats — for the reindeer and for him too — and she’s very much a believer in Santa,” De Laurentiis says. “I hope she’ll be a believer for a long time, I think it’s really fun for kids to be able to do that.”


Recently, the pair sat down to write out Jade’s wish list, but after much pleading on Jade’s part over the past few weeks, it’s no surprise as to what she hopes to find under the tree this year.


“The one thing she keeps asking me for over and over again is clip-on earrings. She must have seen them on somebody else, but she has asked me for clip-on earrings for the past month,” De Laurentiis notes. “I am on a mission to find clip-on earrings for her because I don’t think she’ll ever forgive me if I don’t.”


But based on her newly transformed play space, the “girly girl’s” specific accessory request should come as no surprise.


“She’s opened up her own little salon in her playroom. She gives free makeovers, she curls people’s hair and gives them little manicures as well,” De Laurentiis says. “I’ve always been a girly girl my whole life — maybe she will, maybe she won’t — but it’s a lot of fun to play with her right now.”


– Anya Leon with reporting by Kate Hogan


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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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