Proponents of "developmental" and "difference" theories of mental retardation have long debated the similar structure hypothesis. It holds that when nonorganically impaired retarded and nonretarded persons are similar in developmental level (operationally defined as mental age), they are also similar in the processes and concepts by which they reason. The developmental position endorses this hypothesis; the difference position opposes it. The hypothesis and the debate over its validity have been strongly influenced by Piaget's cognitive developmental theory. In this article we survey 30 studies involving 104 separate tests of the hypothesis with Piagetian conceptual measures. We distinguish between studies that did and did not meet an important procedural requirement: screening organically impaired subjects from their mentally retarded samples. Studies that did not meet this requirement yielded findings inconsistent with the similar structure hypothesis; retarded groups were significantly inferior to nonretarded groups matched on mental age. Studies that did meet the requirement, however, yielded findings supporting the hypothesis. This pattern of findings carries significant implications for the developmental versus difference controversy and for diagnosis and training of the mentally retarded.