A mother brings her 5-year-old daughter to the PMHNP for concerns about her speech articulation. She has never sustained a head injury, was not exposed to prenatal toxins, was delivered vaginally without problems, is otherwise healthy, and is developmentally in line with her peers. She has struggled with speech articulation; her daycare teachers first noticed it and she received speech therapy beginning at that time. She has no issues relating with her peers, and she is highly imaginative in her play. Despite having speech therapy, her speech is still difficult to understand. What is the most likely diagnosis?

Choice A reason: Global developmental delay involves significant delays across multiple domains, including motor, cognitive, social, and language skills. This child is otherwise developmentally normal, so global delay is not appropriate. Choice B reason: Autism spectrum disorder includes deficits in social communication and restricted, repetitive behaviors. The child interacts well with peers and is imaginative in play, making ASD unlikely. Choice C reason: This is the correct answer. Speech sound disorder is characterized by persistent difficulty with articulation or phonological processes that interferes with intelligibility, despite normal development in other areas. Her history fits these criteria. Choice D reason: Selective mutism involves consistent failure to speak in certain social situations despite speaking in others. The child does speak in her environment, so selective mutism is not applicable.