Coastal areas host a significant part of the world population and of humankind’s adaptation needs in the face of effects of climate change, especially sea-level rise and ocean warming and acidification. Atoll islands illustrate frontline situations due to their biophysical (low elevation, small land area, 360°-exposure to waves, limited natural resources and fragile ecosystems) and human (high population densities in urban environments, low level of development, limited technical and financial capacities) characteristics. In these contexts, it is urgent to understand the space for societal adaptation and based on this, identify robust and context-specific adaptation strategies. This essay builds on the hypothesis that, given the nature of atoll islands, understanding the way and extent to which local human-driven disturbances affect the reef-island system’s capacity to provide coastal protection services, is a relevant entry point. Using the case of the Maldives, we propose to combine five types of adaptation into a generic adaptation pathway, and apply it to atoll island types going from no to highly disturbed environments. This work highlights two major conclusions: first, that diverse island profiles require different adaptation pathways; second, that in contexts under high human pressure, the window of opportunities for diversified adaptation strategies is closing fast.