In the season premiere, Alex undergoes an MRI to see if he needs brain surgery after being diagnosed with central apnea. Meanwhile, Jonah wants to get his driver's license; and Anna looks forward to her learner's permit

Amber gives Alex a haircut as he prepares to undergo brain surgery. Meanwhile, Trent takes the other kids to see the Harlem Globetrotters.

Trent vows to lose weight before he turns 40, but the process isn't as much fun as he'd hoped. Meanwhile, Amber plans a surprise party for Trent's birthday that he'll never forget.

Jonah's grades are slipping and Anna would rather do hair and makeup than go to college, so Amber and Trent arrange a college tour to motivate Jonah, and encourage Anna to find a job at a salon to learn the issues facing a little person in the workplace.

Elizabeth navigates uncharted territory when she enters a local beauty pageant. Meanwhile, Trent and Amber takes steps to finalize Emma's and Anna's adoptions.

A busy family week is interrupted when one of the Johnstons is rushed to the hospital in the middle of the night.

Amber is discharged from the hospital in time to help the family throw Anna's sweet-16 party for the ages.

The family needs a break, so the Johnstons take off for a tropical vacation in Puerto Rico. Meanwhile, Amber and Trent ponder adding another member to their brood.