PULLING OUT THE THUMBTACKS: Rethinking Accommodations That Make Students More Sensitive, Not Less

THE PROBLEM WE’RE NOT TALKING ABOUT

Across schools, well-meaning accommodations are sometimes making vulnerable students more fragile. Without understanding the underlying mechanisms, even the most thoughtful supports can backfire.

As someone who works daily with children who have complex, overlapping neurodivergent profiles, I’ve seen how supports that feel compassionate in the moment can create long-term harm when they reduce a child’s ability to cope.

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THE STORY

There was a boy who heard too much,
In every creak, a whispered punch.
A scraping door, a sniff, a sigh,
Each little sound lit up the sky.
He wasn’t scared without a cause,
He flinched because he knew the laws,
Of how the noise comes, sharp and quick,
Like hidden thumbtacks meant to prick.

*From “Thumbtacks” (2025) by Dr. Rae Stout

This poetic description captures something crucial about how certain children experience their environment. For some children, every sound is a jolt to the nervous system. The world feels like it’s always on the verge of striking. This isn’t about being “too sensitive” in the casual sense. It’s a constant readiness for danger, shaping how a child sees every corner of their environment.

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THE RESEARCH REALITY: Overlap Is the Rule, Not the Exception

Neurodevelopmental and mental health conditions rarely exist in isolation. Research shows that 20–40% of autistic individuals have anxiety disorders, with some studies reporting rates as high as 84%. About 9% of autistic individuals meet criteria for OCD, while 47% of people with OCD show significant autistic traits and 28% have an autism diagnosis. Additionally, studies report that “an average of 21% of children and 8.5% of adults with OCD actually have ADHD as well.” Large-scale clinical data reveals that “25% of youth with OCD had a diagnosis of ASD, while 5% of those with ASD had a diagnosis of OCD.”

When accommodations are designed as if these conditions exist in silos, they can unintentionally create the perfect conditions for escalation.

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CASE STUDY: When “Help” Hurts

A student I worked with had misophonia so severe that sniffing noises from classmates triggered aggressive outbursts. The school’s solution was to place him alone in the hallway to eliminate triggers.

At first, it seemed to help. But without the natural masking of classroom noise, his threat detection system began scanning for sounds that weren’t there. Faint noises became exaggerated. He developed compulsive checking behaviors, then began experiencing auditory hallucinations.

A sensory accommodation meant to reduce distress had created a pathway toward OCD-like fixation and even psychotic symptoms. This aligns with research showing how “an overflow of obsessive thoughts results in an overload upon the executive system,” creating what experts call an “Executive Overload model” where symptoms themselves generate cognitive impairment.

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COMMON ACCOMMODATION PITFALLS

1. Extended time without structure→ Feeds OCD cycles of checking, rewriting, ruminating. As research notes, “the more obsessive, intrusive thoughts that an individual experiences in a given moment, the fewer resources would be available for other tasks.”

1. Separate eating or learning spaces→ Entrenches avoidance, reduces resilience

2. Reassurance-heavy counseling→ Fuels dependence on external validation

3. Complete sensory avoidance→ Heightens sensitivity, promotes obsessive searching

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WHY OCD TREATMENT DOESN’T ALWAYS WORK FOR SOUND SENSITIVITIES

In OCD:

Distress is tied to intrusive thoughts and compulsions. Gradual exposure teaches the brain the feared event will not happen.

In misophonia or hyperacusis:

Distress is primarily sensory and neurological. The trigger sound itself is processed as a physical threat. Forcing exposure without careful pacing risks further sensitization and trauma responses.

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DOING IT DIFFERENTLY: Balancing Protection and Growth

The key is distinguishing between anxiety-driven avoidance, which may benefit from gradual exposure, and neurological sensitivities, which may require protection from harmful overstimulation.

Better strategies include:

Time-limited sensory breaks with clear structure:

Instead of indefinite hallway time, provide 10-minute breaks in a designated space with a visual timer, specific calming activities (fidget tools, breathing exercises), and a planned return to class. This prevents the break from becoming avoidance while still offering genuine relief.

Targeted sound management for hyperacusis and misophonia:

Better strategies for sound sensitivity may include use of “tinnitus” maskers, low-gain programmed aids with frequency compression and Bluetooth access to familiar music, and customized FM systems. These tools can be under control of the child for self-advocacy and independence, reducing harmful overstimulation without complete auditory isolation.

Peer support systems for safe, natural exposure:

Pair the student with understanding classmates for structured activities. For example, a lunch buddy system where the student eats with one familiar peer rather than alone, gradually building tolerance for social eating environments.

Environmental changes that reduce but don’t erase manageable challenges:

Use carpet squares to dampen footsteps rather than requiring complete silence, or provide noise-canceling headphones for specific high-trigger activities while maintaining exposure to everyday classroom sounds.

Teaching attention-switching and internal regulation skills:

Train students to redirect focus when they notice hypervigilance starting. Simple techniques like “name 3 things you can see, 2 you can hear, 1 you can touch” can interrupt the scanning cycle before it escalates.

Plans should evolve alongside the child, with constant watch for signs an accommodation is creating new problems.

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THE BREAKTHROUGH MOMENT

When a child starts to feel safe, you can see it in their whole body. The shoulders soften. Breathing evens out. Eyes stop scanning for the next threat. This isn’t about eliminating every challenge, but about building a foundation solid enough for them to meet challenges without going into survival mode.

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EXPERIENCE THE STORY
The full version of the excerpt above is now a song called Thumbtacks. It tells the whole story through music.

Listen here:

https://suno.com/song/e65472fa-13db-487a-a308-0c38de7c3046

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REFERENCES

Abramovitch, A., & Mittelman, A. (2013). OCD and ADHD dual diagnosis misdiagnosis and the cognitive ‘cost’ of obsessions. International OCD Foundation Expert Opinion.

Aymerich, C., Pacho, M., Catalan, A., Yousaf, N., Pérez-Rodríguez, V., Hollocks, M. J., Parellada, M., Krebs, G., Clark, B., & Salazar de Pablo, G. (2024). Prevalence and correlates of the concurrence of autism spectrum disorder and obsessive compulsive disorder in children and adolescents: A systematic review and meta-analysis. Brain Sciences, 14 (4), 379.

Martin, A. F., Jassi, A., Cullen, A. E., Broadbent, M., Downs, J., & Krebs, G. (2020). Co-occurring obsessive-compulsive disorder and autism spectrum disorder in young people: Prevalence, clinical characteristics and outcomes. European Child & Adolescent Psychiatry, 29 (11), 1603-1614.

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If a support increases isolation, dependence, or scanning for danger, it’s not a support. It’s a setup for deeper struggles.

What accommodations have you seen backfire?

Share your experiences below.

#Neurodivergent #ADHD #Autism #OCD #Education #Misophonia #SensoryProcessing #MentalHealth #SpecialEducation #Accommodations