CHICAGO (AP) -- It happened after Columbine, Virginia Tech,
Aurora, Colo., and now Sandy Hook: People figure there surely were signs
of impending violence. But experts say predicting who will be the next
mass shooter is virtually impossible - partly because as commonplace as
these calamities seem, they are relatively rare crimes.
Still,
a combination of risk factors in troubled kids or adults including drug
use and easy access to guns can increase the likelihood of violence,
experts say.
But warning signs "only become
crystal clear in the aftermath, said James Alan Fox, a Northeastern
University criminology professor who has studied and written about mass
killings.
"They're yellow flags. They only become red flags once the blood is spilled," he said.
Whether
20-year-old Adam Lanza, who used his mother's guns to kill her and then
20 children and six adults at their Connecticut school, made any hints
about his plans isn't publicly known.
Fox said
that sometimes, in the days, weeks or months preceding their crimes,
mass murderers voice threats, or hints, either verbally or in writing,
things like `"don't come to school tomorrow,"` or `"they're going to be
sorry for mistreating me."` Some prepare by target practicing, and plan
their clothing "as well as their arsenal." (Police said Lanza went to
shooting ranges with his mother in the past but not in the last six
months.)
Although words might indicate a
grudge, they don't necessarily mean violence will follow. And, of
course, most who threaten never act, Fox said.
Even
so, experts say threats of violence from troubled teens and young
adults should be taken seriously and parents should attempt to get them a
mental health evaluation and treatment if needed.
"In
general, the police are unlikely to be able to do anything unless and
until a crime has been committed," said Dr. Paul Appelbaum, a Columbia
University professor of psychiatry, medicine and law. "Calling the
police to confront a troubled teen has often led to tragedy."
The
American Academy of Child & Adolescent Psychiatry says violent
behavior should not be dismissed as "just a phase they're going
through."
In a guidelines for families, the academy lists several risk factors for violence, including:
-Previous violent or aggressive behavior
-Being a victim of physical or sexual abuse
-Guns in the home
-Use of drugs or alcohol
-Brain damage from a head injury
Those
with several of these risk factors should be evaluated by a mental
health expert if they also show certain behaviors, including intense
anger, frequent temper outbursts, extreme irritability or impulsiveness,
the academy says. They may be more likely than others to become
violent, although that doesn't mean they're at risk for the kind of
violence that happened in Newtown, Conn.
Lanza,
the Connecticut shooter, was socially withdrawn and awkward, and has
been said to have had Asperger's disorder, a mild form of autism that
has no clear connection with violence.
Autism
experts and advocacy groups have complained that Asperger's is being
unfairly blamed for the shootings, and say people with the disorder are
much more likely to be victims of bullying and violence by others.
According
to a research review published this year in Annals of General
Psychiatry, most people with Asperger's who commit violent crimes have
serious, often undiagnosed mental problems. That includes bipolar
disorder, depression and personality disorders. It's not publicly known
if Lanza had any of these, which in severe cases can include delusions
and other psychotic symptoms.
Young adulthood
is when psychotic illnesses typically emerge, and Appelbaum said there
are several signs that a troubled teen or young adult might be heading
in that direction: isolating themselves from friends and peers, spending
long periods alone in their rooms, plummeting grades if they're still
in school and expressing disturbing thoughts or fears that others are
trying to hurt them.
Appelbaum said the most
agonizing calls he gets are from parents whose children are descending
into severe mental illness but who deny they are sick and refuse to go
for treatment.
And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.
All
states have laws that allow some form of court-ordered treatment,
typically in a hospital for people considered a danger to themselves or
others. Connecticut is among a handful with no option for court-ordered
treatment in a less restrictive community setting, said Kristina
Ragosta, an attorney with the Treatment Advocacy Center, a national
group that advocates better access to mental health treatment.
Lanza's
medical records haven't been publicly disclosed and authorities haven't
said if it is known what type of treatment his family may have sought
for him. Lanza killed himself at the school.
Jennifer
Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had
hallucinations, delusions and violent behavior for years. When he was
younger and threatened to harm himself, she'd call 911 and leave the
door unlocked for paramedics, who'd take him to a hospital for inpatient
mental care.
Now that he's an adult, she said
he has refused medication, left home, and authorities have indicated he
can't be forced into treatment unless he harms himself - or commits a
violent crime and is imprisoned. Hoff thinks prison is where he's headed
- he's in jail, charged in an unarmed bank robbery.
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Online:
American Academy of Child & Adolescent Psychiatry:
http://www.aacap.org
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AP Medical Writer Lindsey Tanner can be reached at
http://www.twitter.com/LindseyTanner 
