Supernanny (Season 5, Ep. 2): the Porter Family
Quick Summary and Critique of Therapeutic Methods
by Eric M. Fortier, B.A.
The focus of this Supernanny episode is the Porter family. Madison, their nine year old daughter is depicted crying, screaming, disobeying and hitting her mother Haley repeatedly for being asked to follow basic orders. We see Haley inconsistently giving into Madison’s protests, increasing distress and likely re-inforcing her behavior as a means to get what she wants. What’s more, Madison’s brother Harry has learned some of her behavior, serving to further normalize it. This sometimes becomes so intolerable that Haley and Merryl lose their temper. This reciprocal influence greatly exacerbates familial conflict. Jo suggests that, as a result of the death of Haley’s infant son, she was overbearing with her new daughter Madison, which prolonged Madison’s infantile attachment. By interviewing her separately from her parents, Jo confirms that Madison feels like she has no independence. Merryl also works full time, leaving the bereaved Haley at home to parent Madison and Harry alone for most of the day.
Based on limited evidence of Madison’s externalizing, overt, and destructive behaviors (like destroying a vacuum cleaner), diagnosing Madison as having a Oppositional Defiant Disorder may provide a useful framework for treating her problem behaviors. Madison meets more than the minimum 4 diagnostic criteria for ODD, as she often i. loses her temper; ii. is angry and resentful; iii. argues with authority figures or adults; iv. actively defies or refuses to comply with requests from authority figures or with the rules; v. deliberately annoys others; vi. has been spiteful or vindictive at least twice within the past 6 months; and vii. is associated with distress in the individuals or those around them. Upon careful study, no evidence suggests that the behaviours do not occur exclusively during the course of a psychotic, substance use, depressive or bipolar episode. Madison does not appear to meet the criteria for the more serious diagnosis of Conduct Disorder. It may be worth screening Madison for ADHD or intellectual disabilities, since they are considered risk factors for conduct problems, and Madison appears not to be meeting developmental milestones (as exhibited by a behaviors more reminiscent of a toddler than a normally developing nine year old). Based on the premise that doctors said Haley was unlikely to give birth again after the premature death of her first-born, some neuro-developmental component may be worth investigating.
Jo implements standardized contemporary treatment strategies for conduct disorders to help Madison and the Porter family, including parent management training and problem-solving skills training. Using one-on-one real-time coaching, and by way of example, Jo teaches Haley and Merryl to respond consistently with conditioning contingencies for improving Madison’s compliance, such as by revoking privileges and plans and enforcing a dedicated room for reflection time, but also by using affection, praise and congratulations. Once Jo has established herself as an authoritative and trustworthy figure, she clearly and sternly explains to Madison why her behavior is not acceptable. Jo further implements a list of self-care and basic life-skills that normally developing children of Madison’s age can perform, which Haley had previously been doing for her, aimed at improving her and Haley’s sense of independence. Next, Jo shows Haley a few ways to bond with her daughter. Finally, she teaches Haley and Merryl a three-step process for managing anger, improving their relationship and setting an example for Madison.
A two-week follow-up depicts the Porter family genuinely pleased with the results of Supernanny’s intervention, although this brief commentary might benefit from a supplemental standardized questionnaire. “Life was pretty awful before… and it feels happier… It’s terrific. [Madison] feels so much better, and it was well-needed.” Haley continues by noting that Madison’s tantrums are “over and done with very quickly,” when they do occur. The multi-pronged standardized treatment approach, the early intervention, the positive bond Jo developed with the family, and the promising follow-up commentary, suggests that the behavioral changes may last.
Note: According to some online sources, Haley and Merryl got divorced a few years after the airing of the episode.