Inattention and hyperactivity/impulsivity that feature Attention-Deficit/Hyperactivity Disorder (ADHD) may be challenging in the classroom setting. However, little is known about language teachers’ self-efficacy and the approaches they would employ to deal with context-specific ADHD-like behaviours. Therefore, this mixed-method study used the vignette methodology to investigate the self-reported efficacy and teaching approaches of 62 pre-service English language teachers from Japan, Poland, Turkey, and Ukraine in managing ADHD-like behaviours in six hypothetical classroom scenarios. By comparing diverse educational and cultural contexts, the study aimed to identify convergences and divergences in coping with these behaviours to promote evidence-based approaches in inclusive language teaching. Data were gathered using an online questionnaire with both open- and closed-ended questions on a Likert-type scale. The findings indicate that participants feel moderately confident in managing ADHD-like behaviours; however, some statistically significant country-related differences were observed. A number of similar teaching approaches were identified across the sample, but prominent country-specific differences in approaching specific ADHD-like behaviours were present. The approaches used by participants align with evidence-based recommendations for teaching students with ADHD to some extent. The discussed implications of the study inform pre-service teachers’ education and call for approaches that are more universal in design and language-skill-development-oriented.