Savvyness definitely plays a role. A friend of DD has been in therapy for five+ years, has suffered anxiety the whole time. Whenever her mom (born overseas, now a US citizen) tentatively asked about accomodations, the therapist told the family they weren’t needed. Mom and I talked about it one day. I pointed out that five years of expensive therapy hasn’t been nearly as effective in remedying the kid’s anxiety as a little extra time on some tests might be. That’s a long time to keep an ineffective therapist. As soon as mom suggested that it was time for a change (one way or the other), the therapist changed her tune. The kid now has accomodations, but the results won’t be known until this school year gets underway.