(Photo by Holliday Moore - KJZZ)

Alexander "Xander" Hill at Western Sky Middle School.

Most of Arizona’s middle schools are back in session for the fall by now.

Psychologists and behavioral therapists warn the first few weeks of a new year can be extremely stressful socially and academically.

A sixth-grader at Western Sky Middle School interrogated an unfamiliar face on the Goodyear campus. “Who are you?”

Meanwhile, a seventh-grader asked a classmate, “Are you nervous?”

They should be. Looking at the eighth-graders ahead of them, some appear full grown, while others are eternally childlike. All of them, the American Pediatric Association estimates, will spend the next 12 years on average trying to catch up cognitively.

It’s partly why their language arts teacher did not hesitate to employ a longtime elementary tactic to get her classroom full of seventh-grader’s collective attention.

“If you can hear me, clap twice," she said.

It’s an awkward time for any teen. So, imagine how difficult it is when you are one of two children in a middle-school classroom enduring these critical years with a cognitive disorder. That's how many children the Centers for Disease Control and Prevention estimates are coping in an adolescent school classroom. Thirteen-year-old Alexander Hill — or Xander, as his friends call him — is one of those kids.

“I have tics,” he said. “Some are physical, where I can roll my eyes or move my body. And, I have vocal tics, where I make squeaks.”

He was diagnosed with Tourette’s syndrome in fourth grade, confirming what his mother Krista Hill had wondered when she discovered Xander was compulsively chewing on his shirt while in pre-school.

“I noticed the collar was sopping wet and frayed,” Hill said. “I chalked it up to he was nervous.”

Then when he was beginning third grade in a new neighborhood, he confided in her.

“I was tucking him in and he said, ‘I’m not like the other kids' … and that’s when I knew something was going on,” she said.

Until recently, doctors prescribed medication to try and control the Tourette's tics, but that launched Xander into bouts of rage.

“Yeah, that was bad!” Hill said.

“It gave me extreme anxiety,” Xander said. “It made me miss like 40 days of school.”

The Hills decided this summer to stop the medications and try Comprehensive Behavioral Intervention, a physical therapy program under Dr. David Shprecher’s supervision at Banner Sun Health in Sun City.

On a recent visit, Xander sat fidgeting, firmly focused a box of Lego pieces while echoing his mother in, what he calls, his “Batman voice.”

“When people repeat themselves or others, we call that palilalia or echolalia," Shprecher said.

If it happens in a household or a school where few know about the condition, “that can get people into real trouble,” he said.

So far, Xander appeared to be maintaining most of his tics. When asked if he feels it coming or gets a warning before a tic fires, Xander said, “No, it just happens. I really can’t detect it.”

Four years ago, when his parents began researching Tourette’s, there was no active Tourette’s Association of America chapter in Arizona, and it appeared there were no other kids with it at Xander’s elementary school. But, that was before Shprecher and other neurologists’ research showed Tourette’s syndrome is more common than once believed. 

“It affects about four and a half boys for every one girl that has it," said Shprecher.

In full on cases, where both physical and vocal tics exist, Shprecher estimates about 1 percent, or one in every 100 middle school students, suffers from classic Tourette’s.

Even so, he pointed out, swearing tics — which get an unfair amount of attention — are extremely rare.

“Those only affect about 15 percent of people who have Tourette’s … so, the majority … don’t swear as a tic," Shprecher said.

He suspects there are many undiagnosed students who may not have full blown Tourette’s, but suffer with milder cognitive versions. Their symptoms, he warned, are often masked by other psychiatric conditions, including attention deficit hyperactivity disorder, sensory processing disorder, obsessive compulsive disorder, depression, anxiety and temper tantrums

Keep in mind, the CDC reported children ages 12 to 17, with one or more of those cognitive disorders, are more prone to attempt suicide.

Over the summer months, Xander has worked with Shprecher to learn behavioral cues that will help him manage the tics and outbursts and reduce the severity when one does hit.

Continuing to sift through his Legos, he tried to suppress another tic, but can’t help echoing his mother as she described his frustration. Xander admitted it is taking all he’s got to fight the urge on a daily basis.

When he is at school, Xander said “I really try to focus to stop it because the people would not understand and would get really mad at me, but I know my parents understand."

Many of his classmates understand, too.

(Photo by Holliday Moore - KJZZ)

Alexander "Xander" Hill at Western Sky Middle School.

“Whenever he gets angry sometimes, he like shouts out,” said classmate and friend Amanda Husmoe. “So, I can go over and talk with him and say, ‘It’s OK, work on it now and we can talk later.'”

Part of the reason students are more understanding is because Krista Hill went on the offense to find support for Tourette’s and wound up chairing the Arizona chapter for the Tourette’s Association.  She had to educate herself and set out to educate Xander’s classmates as well.

“In sixth grade, we wanted to educate the whole sixth-grade population because a lot of the kids were coming from different elementary schools who didn’t know Alexander," she said.

The school saw it as an opportunity to talk to kids in each grade who are living with cognitive disorders.

Before Tourette’s was explained on campus, seventh-grader Jackson Hamblin said he never knew Xander was suffering, but now understands.

“(People with Tourette’s), sometimes they have problems, sometimes they have to move their hands and legs," said Jackson.

Before he knew, Jackson said he had heard a few ignorant comments from other kids. Amanda gave her take on making uneducated comments about someone with Tourette’s.

“They shouldn’t make fun of someone for something they can’t do anything about...its something they're born with and cannot change" she said.

Shprecher, who wasn't diagnosed with Tourette’s until he hit medical school, is glad to see children becoming more accepting.

“Things have come a long way,” he said.

 He credits a lot of work over the past couple of decades to the Tourette Association of America.

“Educating people is key to acceptance, whether they be in a wheelchair or have a cognitive disability,” said Hill.

“Because I’m sorry, but, I can’t stop it. I’m just a normal kid who wants to fit in," Xander said.