Familial Retardation

Familial retardation is an obsolete term for mild intellectual disability attributed to environmental or idiopathic (unknown) causes and generally involving some degree of psychosocial disadvantage.

The term familial retardation is no longer used to describe children with mild intellectual disability (ID) that cannot be traced to either genetic or physical causes. Genetic causes account for about 25% of cases of ID and include such disorders as Down syndrome, phenylketonuria, Klinefelter syndrome, and fragile X syndrome. Physical causes of ID account for another 12% of cases and include trauma, problems of pregnancy (fetal alcohol syndrome, rubella, maternal malnutrition), and difficulties in the perinatal period (most often brain damage during a difficult delivery).

Until late in the twentieth century, familial or sociocultural retardation was a catchall category for the 50–80% of children whose intellectual limitations are the result of being born to parents with intellectual disabilities, along with environmental factors that include parental indifference to or rejection of the child; cultural or subgroup attitudes that disparage intellectual achievement; institutionalization; or sensory deprivation. Familial retardation as a category was never clearly defined—a fact noted by several researchers who investigated it from the 1960s into the early 2000s. As early as 1967, one investigator observed, “Considerable order could be brought to the area if, instead of viewing all retardates as a homogeneous group arbitrarily defined by some IQ score, workers would clearly distinguish between the group of retardates known to suffer from some organic defect and the larger group of retardates referred to as familial retardates. It is the etiology of familial retardation that currently constitutes the greatest mystery.”


Holly Ramona walking out of courtroom after giving testimony at malpractice trial against her therapists who are being sued by her father Gary Ramona after they used controversial recovered-memory therapy to help her remember incidents of alleged sexual abuse, April 24, 1994.

Holly Ramona walking out of courtroom after giving testimony at malpractice trial against her therapists who are being sued by her father Gary Ramona after they used controversial recovered-memory therapy to help her remember incidents of alleged sexual abuse, April 24, 1994.
(©John Storey/Getty Images)

In 1989 a young girl named Holly Ramona accused her father of sexual assault following therapy sessions she underwent to recover repressed memories. Her father Gary Ramona disputed the accusations, believing the memories had been implanted by Holly's therapist. He successfully sued the therapist for malpractice in a landmark case. Advocates of the false memory theory allege that false memories may be brought about as a result of certain therapeutic practices, especially those involving hypnosis and guided imagery. Patients may subsequently have trouble differentiating imagined imagery or situations from real memories.

The case of Holly Ramona remains controversial to this day. It led to a sensationalized court case and brought the concepts of repressed memory and false memory into popular culture. The stereotypically “perfect” image of the Ramonas, a wealthy family from Napa Valley, CA, garnered attention in the media.

Holly had entered psychotherapy in 1989 for depression and bulimia. Her therapist Isabella Marche told Holly that eating disorders have been known to stem from trauma and abuse, and that this may have been the case with her. Throughout the sessions Holly gradually began to recount what were described as repressed memories of abuse by her father. She was given sodium amytal (the drug frequently referred to as “truth serum” ) to help her expand upon the fleeting images she was having. Following the treatment she said she had recovered memories of her father raping her over a period of 12 years.

Holly's mother Stephanie believed Holly's claims and immediately divorced Gary, taking their other children with her. Gary subsequently lost his house as well as his job as an executive of a Napa Valley winery.

Although some of the jurors believed that Gary had been a poor parent and that “something had happened” between Holly and her father, they concluded that there was not enough evidence to prove sexual abuse. They judged the therapists as negligent in implanting false memories through their therapeutic techniques on Holly, and awarded Gary $500,000 in damages (although he had requested $8 million). The case marked the first time a non-patient had been allowed to sue a therapist for anything other than suicide or wrongful death. The ruling was seen as sending a message to therapists using the controversial techniques involved with recovered memory. To this day Holly and her mother Stephanie remain adamant that the abuse took place.

The theory of repressed memory was written about by Freud who believed that some painful memories may be stored in the subconscious and kept inaccessible to the conscious mind as a defense mechanism. They may later be triggered by a sensory memory such as a smell. Some trauma researchers have also asserted that traumatic memories are fundamentally different than other memories and that they may become detached in the brain and buried deep in the subconscious. The memories are repressed unless they are recovered, usually involving therapeutic techniques such as hypnosis and guided imagery.

Conversely, false memory researchers including psychologist Elizabeth Loftus, who appeared as an expert witness at the Ramona trial, have argued that the brain and memory are not fixed, but rather extremely suggestible and malleable, and that these techniques are creating false memories in patients rather than “recovering” repressed ones.

Advocates on both sides of the repressed memory debate are vehement in their views on the subject and it remains a very complicated and difficult subject for researchers. It has been shown that memory is not infallible and may be influenced. However, this doesn't necessarily mean that all recovered memories are false. Memory repression is nearly impossibleto study in an experimental setting, as forcing individuals to recall traumatic experiences would break ethical guidelines. Opponents of the false memory theory say that it serves to protect abusers and pedophiles and that given the frequently-underreported nature of sexual abuse, it is dangerous to risk doubting victims’ reports of genuine abuse. The case of Holly Ramona brought attention to this debate and resulted in a landmark case regarding therapeutic malpractice and memory recovery techniques.

In 2013, the American Psychiatric Association(APA) followed the World Health Organization and groups such as the American Association on Intellectual and Developmental Disabilities (AAIDD) in replacing the general term mental retardation with the phrase intellectual disability (ID) or intellectual development disorder (IDD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The reason for the change is that mental retardation had come to be regarded as a stigma or insult. The historical irony here is that the term mental retardation itself was coined in the 1950s to replace terms such as feeble-minded or moron.

New diagnostic criteria

In addition to the change in terminology, the APA introduced a broader set of criteria for mild ID. While a child's IQ score on a standardized test is still recorded, the new definition of ID comprises three domains:

The APA notes that the diagnosis of a child as having mild ID requires a careful clinical evaluation in addition to administration of a standardized IQ test.

The reason for the new criteria is that children may demonstrate different levels of ability in the three domains that affects their adaptive functioning in ways that the IQ score alone cannot reveal. For example, some children with mild ID may have relatively high cognitive skills but severe deficits in interpersonal skills—or the reverse. While mild ID is still characterized as an IQ score two standard deviations below the average, or about 70, the IQ score is no longer the sole determinant of the child's classification as having ID. In addition to evaluating the child in the three domains specified by the APA, the AAIDD urges mental health professionals to take into account language differences among children; cultural differences in the way people talk, move, and behave; and “the community environment typical of the individual's peers and culture.”

Another distinction that is relevant to the APA's changes in nomenclature and diagnostic criteria is the classification of ID as either syndromic (associated with a genetic disorder and characterized by physical malformations or abnormalities) or nonsyndromic (not associated with a genetic disorder and lacking physical deformities). What was formerly termed familial retardation is now identified as nonsyndromic ID.

Epidemiology and management

In general, intellectual disability affects between 1% and 3% of the population of the United States, with 75–90% of affected persons having mild ID. Environmental causes thought to contribute to nonsyndromic ID include the quality of the mother's prenatal care, maternal and child nutrition, family size, the spacing of births within a family, disease, and health risks from such environmental toxins as lead.

The DSM-5 diagnostic criteria for mild nonsyndromic ID do not specify an exact age for evaluation but state that “an individual's symptoms must begin during the developmental period and are diagnosed based on the severity of deficits in adaptive functioning.” In many cases, intellectual deficits are not apparent until children begin school. Mild ID is considered a chronic disorder. Children with mild nonsyndromic ID are at increased risk of a concurrent mental disorder; between 40% and 70% have such conditions as depression, attention-deficit/hyperactivity disorder, and autism spectrum disorder.

See also Diagnostic and Statistical Manual ofMental Disorders (DSM-5); Intellectual disability.


Referring to a disease or disorder of unknown or apparently spontaneous origin.
Intellectual disability (ID)—
A term used to refer to significantly impaired intellectual and adaptive functioning in place of mental retardation.
Syndromic intellectual disability—
Intellectual disability resulting from a genetic disorder or syndrome.



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American Association on Intellectual and Developmental Disabilities (AAIDD), 501 3rd St. NW, Ste. 200, Washington, DC, 20001, (202) 387-1968, Fax: (202) 387-2193, http://aaidd.org .

American Psychiatric Association, 1000 Wilson Blvd., Ste. 1825, Arlington, VA, 22209, (703) 907-7300, (888) 3577924, apa@psych.org, http://psychiatry.org .