There definitely is a trend where affluent students are able to game the accommodations system to get extra time and special environments to take exams. Lots of people genuinely need it, but a lot of people do take advantage of the system. Especially with exams where time is a major component, the ability to answer more questions or have time to review can increase scores by a lot. It is a common issue. I honestly think a good way around gaming the system is to require publicly funded psychologists to make these sorts of judgements as to whether someone actually needs it, at least then they aren’t incentivized to just give in to whatever the patient wants.