Newtown Inspires Country to Spread Kindness

While the shootings at Sandy Hook Elementary School have no doubt left the nation shaken, they have also inspired an outpouring of acts of kindness from across the nation and around the world.

The central hub of many of these is on display in the U.S. Post Office in Newtown, Conn., a community shaken by the killing of 20 children and six school staff members by 20-year-old Adam Lanza, who also killed his mother and shot himself.

Mountains of mail and packages are flowing in from all over the world. Some are simply addressed to "Newtown" or specific families who lost people in the shootings. They're coming with return addresses ranging from Idaho to Virginia Beach and far beyond.

"I think I saw Brazil, Australia, (one addressed to) 'Anybody in Newtown who needs a hug.' It is just amazing," said a postal employee in Newtown.

In the town hall, donated toys are piling up just in time for Christmas.

Kindness is even flowing from victims of other tragedies like Hurricane Sandy, who sent hundreds of teddy bears to hand out to children in the community.

"We've had so much help, we wanted to pay it forward and try to help somebody else," one woman said.

Now, Newtown is hoping people everywhere "pay it forward" in their own communities, with the memory of those lost in the shootings serving as inspiration.

It's a concept that seems to be spreading across America.

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In Michigan, a secret Santa of sorts paid off everyone's layaway items at a store there.

Reports are streaming in on Twitter from around the nation of others receiving coffees or meals paid for anonymously by others.

In New Jersey, Kristen Albright told ABC News she found an anonymous card in her shopping cart at Target, where she had gone to buy ingredients for holiday cookies.

She looked down, and found a gift card to Target inserted into a greeting card that asked her to pay it forward to others, in honor of Newtown shooting victim Catherine Hubbard.

"It really made me stop. I was frozen. It made me think about that little girl," Albright said.

Inspired, she did what the card asked, and gave it to a bank teller at the other end of a deposit she was making. Albright says her 11-year-old son Jackson has begun randomly giving now too.

"It really made me think of the bigger picture and family and friends, and extending that kindness to strangers as well," Albright said.

Stacey Jones of Surprise, Ariz., wrote ABC to say she too has been inspired.

"I went to Target, purchased two gift cards, put them in separate envelopes along with the message and handed them to strangers as I exited the store and entered the parking lot," Jones said. "It really felt good to do a small kind deed for someone."

Nicole Reyes of Boston had never heard of the growing movement of kindness when she found a ziplock bag tucked underneath her windshield on her way to work this morning. Inside, she found a Christmas lollipop with a note on a Christmas card that said it was, "In memory of Emily Parker, 6." And urged her to "Pay it forward!"

"I took a minute to remind myself of how amazing it is that a community and entire nation can come together in the wake of such tragedy," Reyes said. "I ran into my house to show my mother the note. After reading it she immediately started crying. It was a special moment for her and I."

If you would like to share other stories related to this or anything else you can do so by tweeting this correspondent @greenblattmark.

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Egyptians back new constitution in referendum

CAIRO (Reuters) - An Islamist-backed Egyptian constitution won approval in a referendum, rival camps said on Sunday, after a vote the opposition said would sow deep social divisions in the Arab world's most populous nation.

The Islamist Muslim Brotherhood, which propelled President Mohamed Mursi to power in a June election, said an unofficial tally showed 64 percent of voters backed the charter after two rounds of voting that ended with a final ballot on Saturday.

An opposition official also told Reuters their unofficial count showed the result was a "yes" vote, while party spokesmen said there had been a series of abuses during the voting.

The main opposition coalition, the National Salvation Front, responded to the defeat by saying it was moving towards forming a single political party to challenge the Islamists who have dominated the ballot box since strongman Hosni Mubarak was overthrown two years ago.

Members of the opposition, taking heart from a low turnout of about 30 percent of voters, pledged to keep up pressure on Mursi through peaceful protests and other democratic means.

"The referendum is not the end of the road," said Khaled Dawoud, a spokesman for the National Salvation Front. "It is only the beginning of a long struggle for Egypt's future."

The referendum committee may not declare official results for the two rounds until Monday, after hearing appeals. If the outcome is confirmed, a parliamentary election will follow in about two months.

Mursi's Islamist backers say the constitution is vital for the transition to democracy, nearly two years after Mubarak was ousted in a popular uprising. It will provide the stability needed to help a fragile economy, they say.

The constitution was "a historic opportunity to unite all national powers on the basis of mutual respect and honest dialogue for the sake of stabilizing the nation," the Brotherhood said in a statement.

RECIPE FOR UNREST

The opposition accuses Mursi of pushing through a text that favors Islamists and ignores the rights of Christians, who make up about 10 percent of the population, as well as women. They say it is a recipe for further unrest.

The opposition said voting in both rounds was marred by abuses. However, an official said the overall vote favored the charter.

"The majority is not big and the minority is not small," liberal politician Amr Hamzawy said, adding that the National Salvation Front would use "all peaceful, democratic means" such as protests to challenge the constitution.

The vote was split over two days as many judges had refused to supervise the ballot, making a single day of voting impossible.

During the build-up to the vote there were deadly protests, sparked by Mursi's decision to award himself extra powers in a November 22 decree and then to fast-track the constitutional vote.

The new basic law sets a limit of two four-year presidential terms. It says the principles of sharia, Islamic law, remain the main source of legislation but adds an article to explain this. It also says Islamic authorities will be consulted on sharia - a source of concern to Christians and others.

ABUSES

Rights groups reported what they said were illegalities in voting procedures. They said some polling stations opened late, that Islamists illegally campaigned at some polling places, and complained of irregularities in voter registration.

But the committee overseeing the two-stage vote said its investigations showed no major irregularities in voting on December 15, which covered about half of Egypt's 51 million voters. About 25 million were eligible to vote in the second round.

The Brotherhood said turnout was about a third of voters.

The opposition says the constitution will stir up more trouble on the streets since it has not received sufficiently broad backing for a document that should be agreed by consensus, and raised questions about the fairness of the vote.

In the first round, the district covering most of Cairo voted "no," which opponents said showed the depth of division.

"I see more unrest," said Ahmed Said, head of the liberal Free Egyptians Party and a member of the opposition Front.

He cited "serious violations" on the first day of voting, and said anger against Mursi was growing. "People are not going to accept the way they are dealing with the situation."

At least eight people were killed in protests outside the presidential palace in Cairo this month. Islamists and rivals clashed in Alexandria, the second-biggest city, on the eves of both voting days.

(Writing by Edmund Blair and Giles Elgood; editing by Philippa Fletcher)

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Demand for rice in China falls with rising affluence

JILIN: China may be the world's biggest rice consumer, but some say demand will fall, as its people become more affluent and consume more meat and dairy products.

Nearly 200 million tonnes are produced in China each year.

But as grain processing became more mechanized, the appetite of affluent Chinese has also became more polished.

On average, a person in China is said to consume 90 kilograms of rice each year.

While that number is also the highest in the world right now, it is also expected to decrease over time.

With growing affluence, the Chinese are reportedly supplementing their diet with more dairy products, such as milk and cheese.

Meat and other protein-rich products are almost considered staple food.

Changing dietary patterns have led experts to predict that rice consumption in China will fall by half in the next decade.

A similar trend is already seen in countries like Japan and South Korea.

Despite changing dietary habits, Singapore-based Wilmar International remains positive.

"Those who eat more protein and dairy products will also demand for better quality rice. They're after the consumer-pack premium rice, so it won't affect demand," said Wu Zhihua, rice division director of Wilmar International.

"In recent years, consumer-pack rice has reached a volume of 6 to 7 million tonnes and is growing at 4 to 50 per cent each year."

Wilmar International is already China's largest producer of consumer-pack oil, under the brand Golden Dragon Fish.

Wilmar International has set its sights on growing its market share of consumer-pack rice - which currently stands at five per cent - by investing in better crops.

Mr Wu said: "Our investment here will be bigger than the ones for normal padi. The farmer must be incentivized to grow better crop for every order. While it's a huge investment, the unique grade of harvested crop can be processed into better rice and in turn fetch a higher price in the market."

Demand will also be kept up by another trend, where rural residents switch from wheat to a rice diet.

It is enough to drive up this year's projected rice consumption to over 137 million tons.

- CNA/xq

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Sikkim wins best small state award

NEW DELHI: Sikkim has been declared India's 'best small state' by the jury of the IBN7 Diamond State Award, 2012, an official statement from the Sikkim government said on Sunday.

"Sikkim was declared as the best state in the country in the category of small states for its overall achievements. The state was also declared best in the country in citizen security, environment and water and sanitation categories," the statement said.

Lok Sabha Speaker Meira Kumar presented the award to Sikkim chief minister Pawan Chamling in a ceremony here on Saturday night.

Chamling said the state has done a lot for improving the environment and citizen's safety.

"The state has commissioned a regular study of glaciers in Sikkim. Environmental scientists have found that glaciers are not receding in our (Sikkim) Himalayas," Chamling said.

"Sikkim has been rated the most sustainable under various parameters like reducing pressure on environment and state's responses to maintain their environment.

"The government has adopted a very scientific approach towards solid waste management, regulate water usages and discourage encroachment," he said.

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

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

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

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

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

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

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

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

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

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

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

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

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

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

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

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

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

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

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

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

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

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

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

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

___

Online:

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

___

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

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Departing Secretary of State Clinton's Legacy of Firsts

After 31 years of public service, Secretary of State Hillary Clinton leaves the limelight behind.

On Friday, President Obama nominated Sen. John Kerry, D-Mass., to take her place as secretary of state, leaving Clinton to help him move in and then bow out.

Over the past three decades, Clinton has served her country in one way or another, a tenure that was full of firsts.

She was the only first lady to refuse the traditional cookie bake off and the first secretary of state to visit more than 100 countries. She served under the first black president and was the first first lady to have an office in the West Wing of the White House. Clinton was the first secretary of state to visit East Timor, and the first first lady to later win elective office. And long before she ever appeared on a ballot, Clinton was the first child born to Hugh and Dorothy Rodham.

Hillary Clinton Through the Years

Her departure from the State Department does not come as a surprise. For the past year, she has made clear her intentions to step down and said her goodbyes at outposts all over the world.

"It's important for me to step off this incredibly high wire I've been on," Clinton said after casting her ballot in November's presidential election, "to take stock of the rest of my life."

Laurent Gillieron/AFP/Getty Images

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Recently, she told ABC's Barbara Walters she's looking forward to taking a step back, "maybe do some reading and writing and speaking and teaching."

In October, she took the blame for State Department security failures that led to the death of four Americans, including Ambassador Christopher Stevens, in Benghazi, Libya. It was a move that signaled a willingness to put politics aside and embrace responsibility.

I take responsibility," Clinton said a month after the attack in an interview in Lima, Peru. "I'm in charge of the State Department's 60,000-plus people all over the world, 275 posts.

"The president and the vice president wouldn't be knowledgeable about specific decisions that are made by security professionals," Clinton said, a clear attempt to absolve a president who was up for re-election of blame with little regard for her own popularity.

At the end of November, Clinton reflected on her accomplishments as secretary of state over the past four years in two wide-ranging speeches on foreign policy.

Her four years of work focused on advancing rights for women and religious minorities across the globe, helping to maintain the tenuous peace between Israelis and Palestinians, discouraging Iran from obtaining nuclear weapons and, in her own words, "advancing a new approach to development that puts human dignity and self-sufficiency at the heart of our efforts."

Clinton reflected on her travels to more than 112 countries, calling it "shoe-leather diplomacy," and emphasizing the importance of being on the ground.

"I have found it highly ironic that, in today's world, when we can be anywhere virtually, more than ever people want us to show up, actually," she said at the Newseum in Washington, D.C. "Somebody said to me the other day, 'I look at your travel schedule.  Why Togo?  Why the Cook Islands?'  No secretary of state had ever been to Togo before.  Togo happens to be on the U.N. Security Council.  Going there, making the personal investment, has a real strategic purpose."

Though Clinton took political heat this year for her role in the Benghazi attack, her global colleagues joked and prodded her about a second presidential run at each increment of her long-term farewell. The popular Democrat continues to deny she'll run.

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Egypt's constitution seen passing in referendum

CAIRO (Reuters) - Egyptians voted on a constitution drafted by Islamists on Saturday in a second round of balloting expected to approve a charter that opponents say will create deeper turmoil in the Arab world's most populous nation.

Islamist supporters of President Mohamed Mursi, who was elected in June, say the constitution is vital to moving Egypt towards democracy two years after Hosni Mubarak was overthrown in a popular uprising. It will help restore the stability needed to fix an economy that is on the ropes, they say.

But the opposition says the document is divisive and has accused Mursi of pushing through a text that favors his Islamist allies while ignoring the rights of Christians, who make up about 10 percent of the population, as well as women.

As polling opened on Saturday, a coalition of Egyptian rights groups reported a number of irregularities.

They said some polling stations had opened late, that Islamists urging a "yes" vote had illegally campaigned at some stations, and reported some voter registration irregularities, including the listing of one dead person.

The first round of voting last week resulted in a 57 percent vote in favor of the constitution, according to unofficial figures.

Analysts expect another "yes" on Saturday because the vote covers rural and other areas seen as having more Islamist sympathizers. Islamists may also be able to count on many Egyptians who are simply exhausted by two years of upheaval.

If the basic law is passed, a parliamentary election will be held in about two months.

After the first round of voting, the opposition said a litany of alleged abuses meant the first stage of the referendum should be re-run.

But the committee overseeing the two-stage vote said their investigations showed no major irregularities in voting on December 15, which covered about half of Egypt's 51 million voters.

There was no indication on Saturday that the alleged abuses were any worse than those claimed during the first round.

"I'm voting 'no' because Egypt can't be ruled by one faction," said Karim Nahas, 35, a stockbroker, heading to a polling station in Giza, a province included in this round of voting which covers parts of greater Cairo.

At another polling station, voters said they were more interested in ending Egypt's long period of political instability than in the Islamist aspects of the charter.

"We have to extend our hands to Mursi to help fix the country," said Hisham Kamal, an accountant.

Polling stations opened at 8 a.m. (0600 GMT) and close at 7 p.m. (1700 GMT) though voting could be extended as it was last week. Queues formed at some polling stations around the country.

Unofficial tallies are likely to emerge within hours of the close, but the referendum committee may not declare an official result for the two rounds until Monday, after hearing appeals.

MORE UNREST

Even if the charter is approved, the opposition say it is a recipe for trouble since it has not received broad consensus backing from the population. They say the result may go in Mursi's favor but it will not be the result of a fair vote.

"I see more unrest," said Ahmed Said, head of the liberal Free Egyptians Party and a member of the National Salvation Front, an opposition coalition formed after Mursi expanded his powers on November 22 and then pushed the constitution to a vote.

Citing what he said were "serious violations" on the first day of voting, he said anger against Mursi and his Islamist allies was growing: "People are not going to accept the way they are dealing with the situation."

At least eight people were killed in protests outside the presidential palace in Cairo this month. Islamists and rivals clashed on Friday in the second biggest city of Alexandria, hurling stones at each other. Two buses were torched.

The head of the Muslim Brotherhood, an Islamist group that represents Mursi's power base, said the vote was an opportunity for Egypt to move on.

"After the constitution is settled by the people, the wheels in all areas will turn, even if there are differences here and there," the Brotherhood's supreme guide, Mohamed Badie, said as he went to vote in Beni Suef, an area south of Cairo.

"After choosing a constitution, all Egyptians will be moving in the same direction," he said.

The vote was staggered after many judges refused to supervise the ballot, meaning there were not enough to hold the referendum on a single day nationwide.

The first round was won by a slim enough margin to buttress opposition arguments that the text was divisive. Opponents who include liberals, leftists, Christians and more moderate-minded Muslims accuse Islamists of using religion to sway voters.

Islamists, who have won successive ballots since Mubarak's overthrow albeit by narrowing margins, dismiss charges that they are exploiting religion and say the document reflects the will of a majority in the country where most people are Muslim.

(Additional reporting by Tamim Elyan; Writing by Edmund Blair and Giles Elgood; Editing by Andrew Osborn)

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New diagnostic kit allows testing for ricin poisoning

SINGAPORE: A new diagnostic kit developed by Singapore's DSO National Laboratories and the Defence Science Technology Organisation (DSTO) in Australia will allow for the testing of a potent toxin, known as ricin, in humans.

Ricin is found in the common castor bean plant and oil produced from the plant is widely used industrially.

A dose as small as a few grains of salt can kill an adult human if it is inhaled or injected.

The danger of ricin poisoning lies in the symptoms exhibited, which are similar to common food poisoning or respiratory illness.

This makes the diagnosis of ricin poisoning particularly challenging.

Ricin has also been known to be used in biological warfare.

With the new kit, ricin poisoning can be immediately detected, by running human samples such blood and stools, through the kit.

"For this test, we only need 50 micro-litres of sample. That's probably equivalent to two drops if you do a fingerprick," said Chen Hsiao Ying, senior technical staff at the Defence, Medical & Environmental Research Institute.

A person can only be tested after ricin has been in the body for at least eight hours.

Current diagnostic kits can test for ricin contamination in food, soil or water, but not humans.

The new kit will be commercially available in two years' time.

- CNA/xq

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India to open its first drug inspection office in Beijing by Mar 1

NEW DELHI: Increasing the heat on Chinese drug firms exporting medicines to India, the Drug Controller General of India (DCGI) is all set to open its first foreign drug inspection office in Beijing by March 1.

Around four Indian drug inspectors will be posted in China to inspect manufacturing sites and check whether good manufacturing practices (GMP) are being complied with.

DCGI Dr G N Singh told TOI that the commerce ministry has cleared the proposal.

Health minister Ghulam Nabi Azad recently said that in the last two years, 10 Chinese bulk drug manufacturing firms were inspected and the registration certificate of one firm and 16 import licences were cancelled.

Ministry sources said the decision to audit Chinese drug manufacturing units was taken after several import licences of local agents were cancelled due to poor drug quality and their failure to comply with GMP.

"We will post Indian drug inspectors in China to send a clear message that Chinese drug firms are under watch. Gradually, China will be asked to only allow drugs exports from manufacturing sites that have been inspected by Indian drug inspectors. We want to ensure safety, efficacy and quality of Chinese drugs," said Dr Singh.

"GMP of Chinese drug firms has to be certified by our regulators. This is a practice followed in most countries, including the FDA in the US. To protect the interest of Indians, we have to go international," he added.

Now, more than 45% of bulk drug exporters registered in India are from China. The number of registered Chinese bulk drug manufacturers in India is around 280, and altogether 417 different drugs from the Asian giant are registered.

In 2009-10, the value of drugs imported from China stood at Rs 3,094.4 crore, while India's total drug import bill was Rs 4,953.87 crore.

The Planning Commission's working group for the 12th five year plan had said in its report that globalization has fundamentally changed the environment for regulating drug products and created unique regulatory challenges for the following reasons: more foreign manufacturing facilities supplying bulk drugs, medical devices, blood products, diagnostics and anti-cancer drugs to India, increasing volume of imported medicinal products and imports coming from countries with less developed regulatory system.

The document said, "It is therefore important that the Central Drugs Standards Control Organization should have India country offices, at least one each in five countries. Initially, such offices could be set up in China and South Africa to inspect foreign manufacturing facilities and address other regulatory issues. The offices in the other three countries could be set up on a need analysis basis. The financial outlay for each office would be Rs 175 crore."

The Indian pharmaceutical industry has been growing at a rate of 11%-12%. It is the third largest in the world by volume and 13th by value. The total size of the Indian pharma industry is about Rs 100,000 crore, out of which exports account for Rs 42,000 crore. It accounts for 8% of global production, and 2% of the world pharma market.

A ministry official said, "We had earlier written to Chinese Food and Drug Authority (FDA) regarding complaints that some Chinese drug firms which export bulk drugs to India might not be holding proper GMP certificates. The Chinese FDA too confirmed our apprehensions and asked us to carry out our own inspections."

On the basis of complaints and doubts on authenticity of GMP certificate, India has already cancelled 10 registration certificates and related import licences. These certificates were from Zhejinag, Jingsu, Henan province and Chongquing.

A DCGI note said, "Similarly, several cases of imported kits of HIV were declared to be not of standard quality by the government laboratory, which are originating from Zhejiang and Fujian provinces. These issues further support this office which stands to carry out foreign site inspections in line with other regulatory agencies of the world."

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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

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

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