that had not been organized properly, and therefore kept falling out. the young man had a significant improvement in mood and symptoms after 12 sessions of adapted trauma focused cognitive behavioral therapy. eye movement desensitization and reprocessing eye-movement desensitization and reprocessing is a psychological treatment in which the patient's stress is reduced by associating traumatic experiences with bilateral stimulation such as rapid, rhythmic eye movements or tapping. eye-movement desensitization is demonstrated to be highly effective at reducing symptoms of post-traumatic stress disorder across individuals with varying severity of intellectual disabilities; it has the most evidence for treating individuals with developmental disabilities based on numerous case studies. eye-movement desensitization can be adapted for individuals with limited language abilities, making it accessible to a wide range of developmental disabilities. abuse and vulnerability abuse is a significant issue for people with developmental disabilities. they are regarded as a vulnerable people in most jurisdictions. common types of abuse include: physical abuse (withholding food, hitting, punching, pushing, etc.) neglect (withholding help when required, e.g., assistance with personal hygiene) sexual abuse is associated with psychological disturbance. sequeira, howlin, & hollins found that sexual abuse was associated with increased rates of mental illness and behavioral problems, including symptoms of post-traumatic stress. psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behavior. the more serious the abuse, the more severe the symptoms that were reported. psychological or emotional abuse (verbal abuse, shaming and belittling) constraint and restrictive practices (such as turning off an electric wheelchair so a person cannot move) financial abuse (charging unnecessary fees, holding onto pensions, wages, etc.) legal or civil abuse (restricted access to services) systemic abuse (denied access to an appropriate service due to perceived support needs) passive neglect (a caregiver's failure to provide adequate food, and shelter) lack of education, lack of self-esteem and self-advocacy skills, lack of understanding of social norms and appropriate behavior and communication difficulties are strong contributing factors to the high incidence of abuse among this population. a study on the association between different types of childhood maltreatment and the risk of criminal recidivism has also shown that physical neglect during childhood plays a critical role in the repeated crime, independent of mental-health problems for high-risk adults involved with the criminal justice system. in addition to abuse from people in positions of power, peer abuse is recognized as a significant, if misunderstood, problem. rates of criminal offense among people with developmental disabilities are also disproportionately high, and it is widely acknowledged that criminal justice systems throughout the world are ill-equipped for the needs of people with developmental disabilities—as both perpetrators and victims of crime. failings in care have been identified in one in eight deaths of people with learning difficulties under nhs england. challenging behavior people with developmental disabilities (particularly autistic spectrum disorders) can exhibit challenging behavior, defined as "culturally abnormal behaviours of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities". common types of challenging behavior include self-injurious behavior (such as hitting, headbutting, biting, hairpulling), aggressive behavior (such as hitting others, shouting, screaming, spitting, kicking, swearing, headbutting, hairpulling), inappropriate sexualized behavior (such as public masturbation or groping), behavior directed at property (such as throwing objects and stealing) and stereotyped behaviors (such as repetitive rocking, echolalia or elective incontinence). such behaviors can be assessed to suggest areas of further improvement, using assessment tools such as the nisonger child behavior rating form (ncbrf). challenging behavior in people with developmental disabilities may be caused by a number of factors, including biological (pain, medication, the need for sensory stimulation), social (boredom, seeking social interaction, the need for an element of control, lack of knowledge of community norms, insensitivity of staff and services to the person's wishes and needs), environmental (physical aspects such as noise and lighting, or gaining access to preferred objects or activities), psychological (feeling excluded, lonely, devalued, labelled, disempowered, living up to people's negative expectations) or simply a means of communication. a lot of the time, challenging behavior is learned and brings rewards and it is very often possible to teach people new behaviors to achieve the same aims. challenging behavior in people with developmental disabilities can often be associated with specific mental health problems. experience and research suggest that what professionals call "challenging behavior" is often a reaction to the challenging environments that those providing services create around people with developmental disabilities."challenging behavior" in this context is a method of communicating dissatisfaction with the failure of those providing services to focus on what kind of life makes the most sense to the person and is often the only recourse a developmentally disabled person has against unsatisfactory services or treatment and the lack of opportunities made available to the person. this is especially the case where the services deliver lifestyles and ways of working that are centered on what suits the service provider and its staff, rather than what best suits the person. in general, behavioral interventions or what has been termed applied behavior analysis has been found to be effective in reducing specific challenging behavior. recently, efforts have been placed on developing a developmental pathway model in the behavior analysis literature to prevent challenging behavior from occurring. this method is controversial according to the autistic self advocacy network, saying that this type of therapy can lead to the development of post traumatic stress disorder and worsening of symptoms later in life. societal attitudes throughout history, people with developmental disabilities have been viewed as incapable and incompetent in their capacity for decision-making and development. until the enlightenment in europe, care and asylum was provided by families and the church (in monasteries and other religious communities), focusing on the provision of basic physical needs such as food, shelter and clothing. stereotypes such as the dimwitted village idiot, and potentially harmful characterizations (such as demonic possession for people with epilepsy) were prominent in social attitudes of the time. the movement towards individualism in the 18th and 19th centuries, and the opportunities afforded by the industrial revolution, led to housing and care using the asylum model. people were placed by, or removed from, their families (usually in infancy) and housed in large institutions (of up to 3,000 people, although some institutions were home to many more, such as the philadelphia state hospital in pennsylvania which housed 7,000 people through the 1960s), many of which were self-sufficient through the labor of the residents. some of these institutions provided a very basic level of education (such as differentiation between colors and basic word recognition and numeracy), but most continued to focus solely on the provision of basic needs. conditions in such institutions varied widely, but the support provided was generally non-individualized, with aberrant behavior and low levels of economic productivity regarded as a burden to society. heavy tranquilization and assembly line methods of support (such as "birdfeeding" and cattle herding) were the norm, and the medical model of disability prevailed. services were provided based on the relative ease to the provider, not based on the human needs of the individual. early in the twentieth century, the eugenics movement became popular throughout the world. this led to the forced sterilization and prohibition of marriage for those with developmental disabilities in most of the developed world and was later used by hitler as rationale for the mass murder of intellectually disabled individuals during the holocaust. the eugenics movement was later thought to be seriously flawed and in violation of human rights and the practice of forced sterilization and prohibition from marriage was discontinued by most of the developed world by the mid 20th century. in the united states, the segregation of people with developmental disabilities and the conditions of these institutions wasn't widely questioned by academics or policy-makers until the 1960s. us president john f. kennedy, whose sister rosemary had an intellectual disability and was in an institution, created the president's panel on mental retardation in 1961. robert f. kennedy's visit with tv crew to willowbrook state school, which he described as a "snake pit" and the publication the next year of christmas in purgatory, a photoessay featuring photos covertly taken of institutions, shone a light on the inhumane conditions in public institutions. initial efforts focused around reforming the institution; however, that began to change by the late 1960s. the normalization movement began to gain ground in the us and internationally. in the us the publication of wolf wolfensberger's seminal work "the origin and nature of our institutional models", was very influential.this book posited that society characterizes people with disabilities as deviant, sub-human and burdens of charity, resulting in the adoption of that "deviant" role. wolfensberger argued that this dehumanization, and the segregated institutions that result from it, ignored the potential productive contributions that all people can make to society. he pushed for a shift in policy and practice that recognized the human needs of "retardates" and provided the same basic human rights as for the rest of the population. the publication of this book may be regarded as the first move towards the widespread adoption of the social model of disability in regard to these types of disabilities, and was the impetus for the development of government strategies for desegregation.successful lawsuits against governments and an increasing awareness of human rights and self-advocacy also contributed to this process, resulting in the passing in the u.s. of the civil rights of institutionalized persons act in 1980. from the 1960s to the present, most u.s. states have moved towards the elimination of segregated institutions. along with the work of wolfensberger and others including gunnar and rosemary dybwad, a number of scandalous revelations around the horrific conditions within state institutions created public outrage that led to change to a more community-based method of providing services. by the mid-1970s, most governments had committed to de-institutionalization, and had started preparing for the wholesale movement of people into the general community, in line with the principles of normalization. in most countries, this was essentially complete by the late 1990s, although the debate over whether or not to close institutions persists in some states, including massachusetts. individuals with developmental disabilities are not fully integrated into society. person centered planning and person centered approaches are seen as methods of addressing the continued labeling and exclusion of socially devalued people, such as people with a developmental disability label, encouraging a focus on the person as someone with capacities and gifts, as well as support needs. services and support today, support services are provided by government agencies, non-governmental organizations and by private sector providers. support services address most aspects of life for people with developmental disabilities, and are usually theoretically based in community inclusion, using concepts such as social role valorization and increased self-determination (using models such as person centred planning). support services are funded through government block funding (paid directly to service providers by the government), through individualized funding packages (paid directly to the individual by the government, specifically for the purchase of services) or privately by the individual (although they may receive certain subsidies or discounts, paid by the government). there also are a number of non-profit agencies dedicated to enriching the lives of people living with developmental disabilities and erasing the barriers they have to being included in their community. education and training education and training opportunities for people with developmental disabilities have expanded greatly in recent times, with many governments mandating universal access to educational facilities, and more students moving out of special schools and into mainstream classrooms with support. post-secondary education and vocational training is also increasing for people with these types of disabilities, although many programs offer only segregated "access" courses in areas such as literacy, numeracy and other basic skills. legislation (such as the uk's disability discrimination act 1995) requires educational institutions and training providers to make "reasonable adjustments" to curriculum and teaching methods in order to accommodate the learning needs of students with disabilities, wherever possible. there are also some vocational training centers that cater specifically to people with disabilities, providing the skills necessary to work in integrated settings, one of the largest being dale rogers training center in