自闭症谱系障碍（Autism Spectrum Disorders, ASD）是一种发病于童年期且持续终生的神经发育障碍，其存在的核心症状包括社交和语言表达障碍、局限的兴趣范围和刻板行为。心智化（mentalizing）是一种对自我和他人心理状态及其相关行为进行理解和推测的心理能力，而ASD个体在心智化发展方面存在滞后和停滞，进一步影响了社交能力、共情能力和注意力等方面的发展。有研究表明在ASD群体中普遍存在与注意缺陷多动障碍（Attention-Deficit Hyperactivity Disorder, ADHD）的共病现象，且这种共病现象可能在青春期甚至更晚的阶段出现，从而导致终身受损。目前已有多种康复治疗技术被证明能够有效地提高自闭症儿童的能力，但国内对成年人ASD及其与ADHD共病的研究尚不充分。箱庭疗法作为一种有效的心理治疗技术，具有非言语性、不分析、不评价的特点，强调通过创造一个自由与受保护的空间帮助来访者发挥自我治愈力，对于ASD群体的治疗具有独特的优势。

本研究的主要目的是探索箱庭疗法提升自闭症谱系障碍共病注意缺陷多动障碍成人心智化能力的可行性及有效性。研究使用箱庭疗法对一名女性成人来访者进行12次咨询，并使用《自闭谱系商数问卷》、《Conners成人注意缺陷多动障碍自评量表中文修订版》和对来访者的ASD、ADHD症状进行评估，使用《反思功能问卷-54中文版》的心智化缺陷分量表对来访者的心智化能力进行评估，结合量表结果、箱庭作品多角度分析、来访者的主观反馈对干预效果进行评估。

从量表分数的角度看，来访者的《自闭谱系商数问卷》得分由41分降低至27分，《Conners成人注意缺陷多动障碍自评量表中文修订版》得分由161降低至23分，《反思功能问卷-54中文版》的心智化缺陷分量表得分由53分降低至6分；在箱庭作品的阶段性划分上，共分为问题的呈现、探索与反思、转化与成长、整合与治愈四个阶段，逐渐完成了自我的整合和自性的实现；在来访者的主观反馈上，生活中的ASD、ADHD症状有了明显改善，心智化水平有了明显提升，有较好的咨询效果。进一步地，本研究认为在箱庭疗法改善ASD共病ADHD群体的临床症状和提升心智化能力方面，可以从以下五个方面进行作用机制的总结：（1）母子一体性与自我治愈力的发挥；（2）无意识的心象与自性的实现；（3）时空的限制与集中精神力；（4）非言语表达；（5）箱庭疗法的游戏性与故事建构。

本研究得出的结论为：箱庭疗法可以应用于对自闭症谱系障碍共病注意缺陷多动障碍成人的心智化能力的干预，且具有明显的治疗效果和独特的治疗机制。

Autism Spectrum Disorder, abbreviated as ASD, is a neurodevelopmental disorder that occurs in childhood and lasts for a lifetime. Its core clinical features include social and language expression disorders, interest narrowing, and stereotyped behavior. While mentalizing is the ability to understand and speculate on the psychological state of others based on surrounding clues , individuals with ASD have deficits in mentalizing abilities, which in turn lead to deficits in social skills, empathy, and attention. Co-morbidity with Attention-Deficit/Hyperactivity Disorder (ADHD) has been shown to be prevalent in ASD populations, and this co-morbidity may occur in adolescence or even later, leading to lifelong impairment. A variety of rehabilitation techniques have been shown to be effective in improving the abilities of children with autism, but there is insufficient domestic research on adults with ASD and its co-morbidity with ADHD. Sandplay therapy, as an effective psychotherapeutic technique that is non-verbal, non-analytical, and non-evaluative, emphasizes helping visitors exercise their self-healing power by creating a free and protected space, and has unique advantages for the treatment of ASD groups.

The main purpose of this study was to explore the feasibility and effectiveness of sandplay therapy to enhance the mentalizing abilities of adults with the co-morbid condition of attention deficit hyperactivity disorder (ADHD) in autism spectrum disorder (ASD). The study conducted 12 counseling sessions with a female adult visitor using sandplay therapy, and assessed the visitor's ASD and ADHD symptoms using the Autism Spectrum Quotient Questionnaire, the Conners Adult Attention Deficit Hyperactivity Disorder Self-Assessment Scale Chinese Revised Edition, and the visitor's mentalizing ability using the mentalizing deficits subscale of the Reflective Functioning Questionnaire-54 Chinese Edition. The effect of the intervention was assessed by combining the results of the scales, the multifaceted analysis of the sandplay work, and the subjective feedback of the visitors.

From the perspective of scale scores, the visitor's score on the Autism Spectrum Quotient Questionnaire decreased from 41 to 27, the score on the Conners Adult Attention Deficit Hyperactivity Disorder (ADHD) Self-Assessment Scale (Chinese Revised Version) decreased from 161 to 23, and the score on the mentalization deficit subscale of the Reflective Functioning Questionnaire (Reflective Functioning Questionnaire-54, Chinese Revised Version) decreased from 53 to 6. In terms of the stages of the sandplay artwork, there are divided into four stages of problem presentation, exploration and reflection, transformation and growth, and integration and healing, gradually completing the integration of self and the realization of self-nature; in the subjective feedback of the visitors, there was a significant improvement in the symptoms of ASD and ADHD in their lives, and the level of mentalization improved significantly, with a better counseling effect. Further, this study concluded that the mechanism of action can be summarized in the following five aspects in terms of the improvement of clinical symptoms and the enhancement of mentalizing ability in ASD co-morbid ADHD groups by sandplay therapy: (1) mother-child oneness and the exertion of self-healing power; (2) unconscious mental images and the realization of self-nature; (3) temporal and spatial constraints and the concentration of mental power; (4) non-verbal expression; (5) the sandplay therapy's playfulness and story construction.

This study concludes that the sandplay therapy can be applied to intervene the mentalizing ability of adults with the co-morbid attention deficit hyperactivity disorder (ADHD) of autism spectrum disorders, and that it has significant therapeutic effects and unique therapeutic mechanisms.