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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Afghan policewoman kills coalition contractor in Kabul: NATO

KABUL (Reuters) - An Afghan woman wearing a police uniform shot dead on Monday a civilian contractor working for Western forces in the police chief's compound in Kabul, NATO said.

The incident is likely to raise troubling questions about the direction of an unpopular war.

It appeared to be the first time that a woman member of Afghanistan's security forces carried out such an attack.

There were conflicting reports about the victim.

A spokesman for the NATO-led International Security Assistance Force (ISAF) said a U.S. police adviser was killed by an Afghan policewoman. Then ISAF said in a statement only that it was a "contracted civilian employee" who was killed.

Mohammad Zahir, head of the police criminal investigation department, described the incident as an "insider attack" in which Afghan forces turn their weapons on Western troops they are supposed to be working with. He initially said the victim was a U.S. soldier.

After more than 10 years of war, militants are capable of striking Western targets in the heart of the capital, and foreign forces worry that Afghan police and military forces they are supposed to work with can suddenly turn on them.

The policewoman approached her victim as he was walking in the heavily guarded police chief's compound in a bustling area of Kabul. She then drew a pistol and shot him once, a senior police official told Reuters.

The police complex is close to the Interior Ministry where in February, two American officers were shot dead at close range at a time anger gripped the country over the burning of copies of the Muslim holy book at a NATO base.

"She is now under interrogation. She is crying and saying 'what have I done'," said the official, of the police officer who worked in a section of the Interior Ministry responsible for gender awareness issues.

TIPS FOR TROOPS

The insider incidents, also known as green-on-blue attacks, have undermined trust between coalition and Afghan forces who are under mounting pressure to contain the Taliban insurgency before most NATO combat troops withdraw by the end of 2014.

Security responsibilities in a country plagued by conflict for decades will be handed to Afghan security forces.

Many Afghans fear a civil war like one dominated by warlords after the withdrawal of Soviet occupying forces in 1989 could erupt again, or the Taliban will make another push to seize power if they reject a nascent peace process.

At least 52 members of the NATO-led International Security Assistance Force have been killed this year by Afghans wearing police or army uniforms.

Insider attacks now account for one in every five combat deaths suffered by NATO-led forces in Afghanistan, and 16 percent of all U.S. combat casualties, according to 2012 data.

Hoping to stop the increase in the attacks, Afghan Defense Ministry officials have given their troops tips in foreign culture.

They are told not to be offended by a hearty pat on the back or an American soldier asking after your wife's health.

NATO attributes only about a quarter of the attacks to the Taliban, saying the rest are caused by personal grievances and misunderstandings. Last year, there were 35 deaths in such attacks.

Afghan forces are vulnerable to "insider attacks" of their own. In Jawzjan province in the north, a police commander shot and killed five comrades overnight, the Interior Ministry said.

Last year, he defected from the Taliban, said the ministry.

Taliban spokesman Zabihullah Mujahid said in a statement that the commander had rejoined the Taliban. That could not be confirmed.

(Writing by Michael Georgy; Editing by Robert Birsel)

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New industries revitalising China's north eastern region

BEIJING: Once a thriving industrial base, China's north eastern region slipped into depression when several state-owned enterprises shut down in the 1990s as part of economic restructuring.

Still, growth is now slowly but surely returning to the region.

A currency exchange built by the Japanese during World War Two is still in use today in China's northeastern city of Changchun in Jilin Province.

Now home to a bank, the Grecian-style building is a reminder of the city's past, when it was once the capital of Manchuko, a puppet-state under Japanese occupation.

Today, Changchun is better known as China's automobile capital.

But more recently, car sales nosedived following the anti-Japanese protests.

This comes as some major Chinese cities like Guangzhou imposed car ownership restrictions to clean up the air and road conditions.

Chen Werigen, Vice Mayor of Jilin Province, said: "It's impossible we're not affected. But people would now buy cars they like more than before, or cars of better quality and that creates more opportunities for sales. Secondly, we also have a huge rural market that doesn't restrict car ownership. And we're developing new energy vehicles for export. These are the measures we're taking to manage car ownership restrictions in some cities."

But Changchun faces other challenges like the slow growth of private enterprises and poor transport links, with construction of a subway only starting in 2010.

Changchun as part of the northeast was one of the first to industrialise and prosper. But they fell back in the 1990s during the restructuring of state-owned enterprises and hundreds of thousands went jobless.

Things only started looking up after the new millennium when China's central government implemented reforms to revitalise the region.

These include encouraging private companies like Haoyue, China's largest Islamic beef-processing firm by export volume, to set up base.

It now hires 20,000 people at its plant, and accounts for half of China's total exports of beef products to 23 countries, including the Middle East and Russia.

The firm is now diversifying into the production of animal feed, another industry which authorities in the northeast are keen to develop.

Zhang Guohua, CEO of Haoyue Group, said: "For the next five years, we'll increase our investment in animal feed production. The aim is to make us the biggest manufacturer and seller of animal feed amongst the three provinces in the northeast."

And hopefully that will pave the way for greater economic growth in Changchun in the long term.

- CNA/de

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Two LeT militants, policeman killed in encounter in J&K

SRINAGAR: Two Lashker-e-Taiba militants, allegedly involved in an attack on a hotel in the city, and a policeman were killed in a fierce gunbattle between security forces and ultras in Kulgam district of south Kashmir on Monday.

The gunfight erupted in Dodhipora village, some 75-km from here, when a joint team of police and Rashtriya Rifles launched a search operation to flush out hiding militants, a police spokesman said.

Security forces confronted the ultras and in the ensuing gunbattle, two LeT ultras and a policeman were killed, he said.

The slain militants were identified as Mudasir Sheikh alias Mavia, a self-styeld district commander, and his Pakistani associate Tamim.

"Both the militants were involved in an attack on a prominent hotel on the outskirts of Srinagar last October," the spokesman said.

Two hotel employees were killed when militants opened fire on Silver Star hotel and an army convoy passing through Lasjan bypass on October 19.

On December 19, six hardcore LeT militants were killed in a gunfight with security forces in Sopore town in north Kashmir's Baramulla district.

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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

___

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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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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