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My psuedodragon familiar is currently under the effect of Hold Monster. Hold monster specifically restricts "speech", but I think that means words that come out of a moving mouth.

Is that right? Can it communicate using its telepathy?

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A held monster can use telepathy.

Per the spell hold person (referenced in hold monster, the Condition imparted is paralysis.

A paralyzed character is frozen in place and unable to move or act. A paralyzed character has effective Dexterity and Strength scores of 0 and is helpless, but can take purely mental actions. A winged creature flying in the air at the time that it becomes paralyzed cannot flap its wings and falls. A paralyzed swimmer can’t swim and may drown. A creature can move through a space occupied by a paralyzed creature—ally or not. Each square occupied by a paralyzed creature, however, counts as 2 squares to move through.

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