Your child doesn't want to go to school. It's a daily struggle that many parents are familiar with.

But what if your child refuses to go to school?

Mental health professionals and educators say what used to be considered run-of-the-mill truancy could actually be something else. Some cases of chronic absenteeism are now being called "school refusal," which is triggered by anxiety, depression, family crises and other traumatic events. It can lead to weeks or even months of missed school days.

The Anxiety and Depression Association of America estimates anxiety-based school refusal affects 2 to 5 percent of school-age children. It is often triggered when students are transitioning into middle or high school. Doctors say it should be treated with flexibility and therapy - not punishment.

"Before you are even in the building, the mind is racing," says Matt Doyle, a therapist and clinical social worker in Massachusetts. He tells Here & Now's Robin Young, it's like "the domino effect."

"So the perceived inability to complete a homework assignment creates this sense of panic and dread: 'What's coming the next day? Am I even going to sleep tonight? What are my parents going to say? What are my friends going to say, because I've come for the fifth day in a row with no homework?' "

As the anxiety snowballs, many children will refuse to even get out of bed in the morning, Doyle says. Some suffer physical symptoms such as panic attacks and stomach aches.

The cause of school refusal is different for every child, but Emanuel Pariser, of the Maine Academy of Natural Sciences, says it likely reflects the heightened state of stress and anxiety in today's society. He also tells Young it comes down to trust.

"I do feel like the immediate cause for our kids is some kind of rupture in their relationships with adults, and that school does not feel like a safe place for them to be. And when you look at Maslow's hierarchy of needs, safety is the No. 1. If they don't feel they're safe, they cannot learn," says Pariser, referring to the psychological theory of human motivation.

Some schools are employing new strategies. The Threshold Program at the Maine Academy of Natural Sciences, which is a public charter high school, sends teachers into the homes of students. The school is four weeks into the program. Twenty-one students are enrolled, 18 of whom are diagnosed or identify as having some type of social anxiety.

Teachers develop a curriculum for each student that is tailored to something that interests them, Pariser says.

"We want them engaged in the act of learning," he says, which begins with developing trust between the teacher and student.

Similar to the Threshold Program, Doyle, the clinical social worker from Massachusetts, calls his work "home-based intervention," in which he and his colleagues observe parents' struggles to get a child to school.

"I typically pull up a chair next to this child's bed, and we talk about what's going on, 'Help me understand a little bit about what is happening this morning,' " Doyle says. "And the things I hear about are very diverse," ranging anywhere from social bullying to online harassment.

Doyle says by reframing chronic absenteeism as a mental health issue — not a behavioral problem — helps children ease back into the classroom.

"For example, having a greeter at the school, making it feel like a welcoming environment for that child to come to, versus, 'Two more times and the truancy officer will be coming to your home,' " Doyle says.

On the other hand, even if kids have to stay at home, they can still make progress, Pariser says. Since the Threshold Program started in September, some students have started to go back to school, while others are still stuck in similar patterns.

"Our overarching goal is to get them to graduate from high school," he says, "and if we can work them back into a more conventional school environment, that is great."

While some critics dismiss these programs as coddling students, Pariser says most kids are not trying to manipulate their parents when they refuse to go to school.

"It is much more often an act coming out of fear and coming out of a sense of a lack of empowerment as opposed to a sense that you can push back on things and get what you want," he says.

Copyright NPR 2019.