A patient refuses to speak in specific social situations but communicates normally otherwise. What is the diagnosis?

Selective Mutism is characterized by a consistent inability to speak in certain social situations where there is an expectation to communicate, such as at school or with peers, while the individual is able to speak normally in other settings, usually at home or with close family members. This condition typically begins in childhood and can lead to significant impairment in social interactions and academic performance.

The key aspect of Selective Mutism is the contrast between the ability to communicate in some environments and the refusal or inability to do so in specific situations. This differs from Social Phobia, where the fear of social interactions can be pervasive but does not include a complete lack of speech; rather, individuals may be anxious but still speak. Generalized Anxiety Disorder encompasses a wider range of anxiety symptoms and is not limited to specific social situations, and it typically includes excessive worry about various aspects of life, rather than just communication in certain contexts. A Speech Delay would indicate difficulties with speech development rather than a selective inability to communicate in certain situations. Therefore, the characteristics described align perfectly with the diagnosis of Selective Mutism.